Senior Benefits Configuration Analyst
SmithRx
full-time
Posted on:
Location Type: Remote
Location: United States
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Job Level
About the role
- Work with clients, identifying and understanding benefit plan requirements. Build and maintain pharmacy benefit plans for client groups.
- Own all aspects of benefit configuration organization and structure for the accounts assigned by monitoring plan data integrity.
- Spearhead process improvement efforts.
- Provide support to team members for escalations and complex configuration requests.
- Create and maintain prior authorizations and step therapy rules.
- Grandfather/transition new clients and update formularies with changes at the direction of the clinical team.
- Communicate project status, escalating issues when appropriate. Drive changes to improve workflow efficiency.
- Collaborate with member support and customer success teams to review and resolve inquiries related to benefits timely to improve member experience.
- Provide troubleshooting support for our claims adjudication process.
- Collaborate with engineers on system enhancements to drive automation.
- Interface with external vendors surfacing issues and tracking outstanding work requests.
- Support new client implementations, conduct go-live testing, perform post go-live auditing and support to ensure plans are configured to confirm accuracy.
Requirements
- Bachelor's degree or equivalent work experience in healthcare and/or PBM required.
- 6+ years of experience in benefits configuration with a healthcare or health insurance organization required
- Robust analytical skills; Advanced skills in Microsoft Excel;
- Strong communication skills via face-to-face meetings, conference calls and written correspondence
- Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments
- Execution-focused ethos - you are a solutions-oriented problem solver and efficiency driven
- Flexible, dependable, adaptable, and able to respond under the pressure of a fast-paced technology company
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
benefit configurationpharmacy benefit plansprior authorizationsstep therapy rulesclaims adjudicationdata integrityanalytical skillsMicrosoft Excelprocess improvementautomation
Soft skills
communication skillsself-starter mentalityproblem solvingefficiency drivenflexibilitydependabilityadaptabilitydecision makingcreativitycollaboration
Certifications
Bachelor's degree