Benefit Business Support

Job Description

Job Description

POSITION SUMMARY

The Benefit Client Support is responsible for client DEMOS regarding the OneArk system and voice recordings for PharmPix. This role will also support client training and presentations, as needed. This position reports to the Benefits Supervisor and is responsible for setting up business rules in the adjudication system for all PharmPix clients, test claims and perform quality assurance reviews to ensure desired results.

ESSENTIAL ROLES AND RESPONSIBILITIES

1. Perform accurate client benefit set up for all business rules for PharmPix clients.
2. Implement new and maintain existing benefit plans, rates, and networks in the OneArk system, consistent with the direction and intent set forth by the client and PharmPix.
3. Properly enter test claims to verify business rules set up in the system.
4. Perform quality assurance reviews on set up performed by other team members to ensure accuracy.
5. Proactively identifies issues or weaknesses, analyzes ways to resolve them and presenting these to the Benefit Supervisor, Manager and/or Director.
6. Become Subject Matter Expert on OneArk functionality to support the Operational areas and backend clients.
7. Support with QIA team requests or tickets.
8. Support client consults regarding benefit configuration and formulary.
9. Works with the Benefit team, Account Management and Quality Internal Audits to evaluate complex customer problems, identify root causes and derive resolutions.
10. Supports UAT process from the Benefit perspective. This includes, but is not limited to:
    1. Developing and executing test plans, scenarios, scripts or procedures based on change specifications.
    2. Identifying and reporting any defects, bugs or design flaws in the software.
    3. Collaborating with other testers, developers and stakeholders to ensure the quality and readiness of the system.
11. Responds in a timely manner to all requests and consults.
12. Responsible for preparing and giving system demonstrations to potential clients and / or when required by the Sales Team.
13. Support internal or external client presentations or training. Create effective and visually appealing presentations for both internal and external clients.
14. Meet deadlines under pressure and communicate issues proactively to personnel in charge such as Implementations Director and/or Sales representative.
15. Display exceptional client service skills and the ability to support internal and external clients promptly.
16. Analyze client system requests and work to accommodate within existing systems before having to recommend system enhancements.
17. Identify discrepancies, inaccuracies, and unintended consequences, and take corrective action.
18. Research and respond to claims processing and system configuration inquiries from internal departments and backend clients.
19. Support all Quality Management Program initiatives.
20. Perform other duties as assigned.

TRAINING & EDUCATION

• Pharmacy Technician Associate Degree or equivalent professional experience.

LICENSURE / CERTIFICATION

• Puerto Rico Board of Pharmacy Technician Certification (Preferred).

PROFESSIONAL EXPERIENCE

• One (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy or; Proven working experience as a data analyst.

PROFESSIONAL COMPETENCIES

Knowledge:

• Experience in health insurance industry or PBM is desired.
• Knowledge of federal and The Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies is preferred.

Skills:

• Must be detail oriented and highly organized.
• Accurately analyze and interpret common Pharmacy Benefit terminology.
• Manage multiple priorities and work independently in a fast-paced environment.
• Proficiency in Microsoft Office.
• Possess a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
• Strong verbal, written and presentation communication skills.

• Display exceptional client service skills.

Abilities:

• Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.
• Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals.
• Ability to read and interpret documents, write reports and correspondence.

• Ability to organize and integrate organizational priorities and deadlines.
• Ability to work independently or part of a team.

• Fully bilingual English and Spanish (Required).
• Ability to support clients with technical difficulties in a timely manner.

• Strong problem analysis and decision-making skills.

PHYSICAL AND MENTAL DEMANDS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear, sitting, standing, and walking
• The position requires that weight be lifted, and force be exerted up to 25 pounds.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ENVIRONMENTAL AND WORKING CONDITIONS

• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Require evening or weekend work.

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans