Medical Reviewer III, Medicaid
Empower AI
Benefits Configuration Analyst
Pharmacy Data Management, Inc. (PDMI)
full-time
Posted on:
Origin: • 🇺🇸 United States • Ohio
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Analyze and implement new client setups and benefit design changes with accuracy
- Configure and maintain benefit plan logic in PDMI’s proprietary claims adjudication system
- Document configuration decisions and validate coding changes through testing and peer reviews
- Partner with internal teams to resolve issues and support client needs
- Stay current on system upgrades and maintain expertise in technical and operational aspects
- Share knowledge, mentor team members, and contribute to process improvement initiatives
- Ensure compliance with HIPAA, NCPDP, and other regulatory standards
Requirements
- Minimum four-year college degree preferred or equivalent industry (i.e., healthcare or insurance) experience
- Must have prior experience with benefits and compiling analytical data and reports
- Background encompassing electronic claims processing preferred
- Knowledge of HIPAA, NCPDP, and other regulatory standards
- Analytical ability to interpret data, solve problems, and make informed configuration decisions
- Technical proficiency in benefits configuration, systems logic, and documentation
- Quality focus with strong attention to detail, accuracy, and peer-review standards
- Collaboration and communication skills to work effectively with internal stakeholders
- Adaptability and initiative to navigate change and manage priorities
- Commitment to professional growth and staying current with industry practices and technology
