Prescription Plan Design & Escalations Analyst

Overview

On Site
Accepts corp to corp applications
Contract - W2
Contract - Independent
Contract - Long Term

Skills

Supervision
Forms
Auditing
Reporting
Evaluation
Research
Pharmacy
Benefits Management
Microsoft Excel
Data Entry
Analytical Skill
Oracle UCM
LinkedIn

Job Details

Hi

I hope you are doing well!

I came across to your profile for this position please let me know if you are available in job market, it is fast moving opportunity and client want to star ASAP.

Kindly let me know, are you Comfortable with this Position then please share me your updated resume .

Please reply me with your updated resume

Title: Prescription Plan Design & Escalations Analyst

Location: Phoenix, Arizona | Onsite

Duration: 6-12+ Months

Job Description:

PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW

  • Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
  • Support internal and external customers with information on benefits applicable to medication claims
  • Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
  • Communicate recommendations in regard to medication claim processing and benefit decisions.
  • Monitor and investigate reported plan set up system issues
  • Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
  • Resolve escalated member issues
  • Research & provide recommendations for accumulations issues
  • Logs all benefit setup issues on error tracking reports

Ideal Candidate Profile Experience:

  • Highly preferred: 3-4 years of experience with Rx claims or PBM (Pharmacy Benefit Management)
  • Background in medical claims or related field

Technical Skills:

  • Strong Excel or Excel-like tool proficiency
  • VLOOKUPs
  • Filtering and updating spreadsheets
  • Using basic formulas in spreadsheets
  • Comfortable handling large datasets quickly and accurately

Nice to Have:

  • Data entry experience with an analytical mindset
  • Experience in Rx claim/PBM work

Best regards,

Lavesh Kumar

| Sr. Technical Recruiter

STELLENT IT A Nationally Recognized Minority
Certified Enterprise

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