Prescription Plan Design & Escalations Analyst 1-4

LEVEL 1 - 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
* Provide monthly updates on error resolutions and impact reports
* Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
* Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
* Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3).

RX claim exp, PBM exp, spreadsheet knowledge, data entry, analytical background, medical claims background. Pharmacy programming and claim oversize. Strong excel knowledge. Look into pharmacy claims if there are any issues in it. 3-4 years exp is enough