PBM prescription claim Analyst - BCBS of Arizona
ShiftCode Analytics
Job Title
Interview: Onsite Visa: USC and GC Hybrid: Phoenix, AZ (need local) JD:
Job Description:
- 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
Ideal Candidate Profile Experience:
- Highly preferred: 3-4 years of experience with Rx claims or PBM (Pharmacy Benefit Management)
- Background in medical claims or related field
Technical Skills:
- Strong Excel or Excel-like tool proficiency
- VLOOKUPs
- Filtering and updating spreadsheets
- Using basic formulas in spreadsheets
- Comfortable handling large datasets quickly and accurately
Nice to Have:
- Data entry experience with an analytical mindset
- Experience in Rx claim/PBM work
Vacancy posted 4 days ago
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