A Plan Analyst is responsible for the analysis, design and deployment of a client’s pharmacy benefit in Rx Claim.
Responsibilities :
Responsible for reviewing, analyzing, and implementing desired plan benefit features, including formulary loads and performing quality assurance checks by testing claims against the desired benefit design, in a timely fashion for Commercial Clients.
Design, Development and Deployment of Client Benefit Plan Design Parameters for both New Business and Existing Client Relationships for Commercial Clients.
Ensures accurate claim processing by correcting and communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required.
Quality Assurance Testing of the Claims Processing System Enhancements and System Patches.
Coordinates with internal customers to ensure the documentation, implementation, and modification of benefit plans is prepared, reviewed, and completed in a timely fashion, and is updated according to the department’s standard operating procedures and IRX policy and legal requirements.
Responsible for researching, testing, and responding to inquiries regarding system capabilities and system problems related to plan benefit design from other internal departments such as Account Management, Customer Care, Quality Assurance or other internal departments.
Internal Support changes to IRXNetworks, Building Blocks, etc.
Other assigned activities as determined by the Manager of Benefit Services.
Qualifications :
Experience using RxClaim adjudication platform is a plus
Ability to read, analyze, and interpret general business and/or technical procedures.
Excellent written and oral communication skills
Experience with Microsoft Office Products is required
Ability to adapt to a changing work environment including scheduling flexibility.
Ability to apply concepts such as fractions, percentages, and proportions to practical situations.
Ability to define problems, by collecting data, establishing facts, and drawing valid conclusions.
2 years experience in a Heath Care or related field – Pharmacy knowledge or related experience with a general understanding of plan benefit design preferred.
Direct experience working with clients preferred.
High School Diploma required. College or University level education is a plus.
Catamaran - 2 years ago
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