MedOne Pharmacy Benefit Solutions

Account Manager

• Assists account management and member advocate teams with research, resolution, and reconciliation of member and client issues such as cost share and eligibility inquiries
• Assists team with projects such as gathering and stratifying client data, running plan utilization report packages, and updating client documentation
• Provides and clarifies plan design and process information to internal teams to help resolve issues and improve efficiencies
• Serves as back-up to the member advocate team when call volume is high
• Represents MedOne at client benefit fairs and open enrollment meetings
• Reconciliation of claim errors, including identification of member and client impact and subsequent communication to all parties
• Assists with new client and vendor onboarding tasks
• Creates and maintains member and client facing materials e.g., member plan design brochure and FAQ, open enrollment materials, and member letter templates
• Creates and maintains internal materials e.g., process and training documentation and data requests
• Completion of plan design testing within and outside of claim adjudication system
• Assists with CRM maintenance, report pulls, and enhancement projects
• Contributes to department and company goals

Account Coordinator

Project Manager

• Assists account management and member advocate teams with research, resolution, and reconciliation of member and client issues such as cost share and eligibility inquiries.
• Assists team with projects such as gathering and stratifying client data, running plan utilization report packages, and updating client documentation.
• Provides and clarifies plan design and process information to internal teams to help resolve issues and improve efficiencies.
• Serves as back-up to the member advocate team when call volume is high.
• Represents MedOne at client benefit fairs and open enrollment meetings.
• Reconciliation of claim errors, including identification of member and client impact and subsequent communication to all parties.
• Assists with new client and vendor onboarding tasks.
• Creates and maintains member and client facing materials e.g., member plan design brochure and FAQ, open enrollment materials, and member letter templates.
• Creates and maintains internal materials e.g., process and training documentation and data requests.
• Completion of plan design testing within and outside of claim adjudication system.
• Assists with CRM maintenance, report pulls, and enhancement projects.
• Contributes to department and company goals.

Implementation – Project Manager

• Build and maintain business relationships by providing prompt and accurate service to promote customer loyalty
• First point of client contact for general inquiries such as escalated member issues, plan design questions, etc.
• Assist with onboarding new clients
• Manage client’s pharmacy benefit design updates, projects, and follow-ups
• Organize and maintain client documentation within and outside of CRM
• Interact directly with internal and external clients to build positive relationships
• Analyze plan performance reporting; interpret data and identify correlations, trends, and opportunities
• Plan for and lead client and partner plan performance review meetings; promote programs and services to clients and business partners when appropriate
• Understand contract structure, track plan performance against contract terms, and communicate performance to plan and business partners
• Serve as back-up to the Member Advocate team when call volume is high
• Research and resolve issues pertaining to eligibility, claim adjudication, and billing
• Attend client benefit fairs and open enrollment meetings
• Contribute to department and company goals
• Work collaboratively and cooperatively with other departments to resolve issues and improve processes

Underwriter

• Use proprietary Underwriting and Pricing Models, Excel, and SQL to model both prospective and existing client pharmacy spend, their underlying drivers of cost, as well as MedOne’s profitability.
• Analyze pharmacy claims data and develop reports for operations, sales and other key business units.
• Support the financial aspects of PBM Request for Proposals (RFPs), and client market-checks to include coordinating PBM data requests, completing financial evaluation, and completing formulary and network evaluations.
• Assist with research, recommendations, and implementation of technology changes and reporting to improve accuracy of the Underwriting Model and optimize financial responses to PBM RFP procurement.
• Complete formulary and network disruptions to aid in the onboarding process of new clients.
• Ability to work closely with Subject Matter Experts (such as Clinical, Proposal Services, and Rebates) teams to incorporate their most up to date guidance seamlessly into the Underwriting Model.
• Collaborate with other departments in Strategic Pricing business unit on analyses and/or projects.
• Active participation and/or ownership in both quarterly and annual business unit priorities.
• Other duties as assigned.

Account Coordinator

Implementation – Project Manager

Account Manager

Pharmacy Underwriting Analyst