PBM Operations Analyst (Rx claim adjudication, eligibility, benefits, testing) |
Samprasoft
100% TELECOMMUTE
OVERVIEW: OptumRx Core PBM Operations role is critical to M3P initiative. This role is responsible for development and execution of end-to-end client testing that must be completed in 2024.
METRICS: This position is required to complete M3P concurrent client testing for 30+ new/existing clients.
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the PBM Operations Analyst (Rx claim adjudication, eligibility, benefits, testing) | in United States vacancy
- ...Senior Business Analyst We are... ...will have deep PBM domain expertise... ...in PBM domain (Claims processing related... ...understanding of Pharmacy Benefit Management (PBM... ...Claims Adjudication, Data related processes (e.g. Eligibility data, Provider... ...and Testing team) and non-Conduent...Claims
$78.8k - $98.5k
...including: Capital Rx , a public benefit corporation... ...management (PBM) solutions to... ...all claim administration... ...supporting the testing and validation... ...confirm expected adjudication behavior and accumulator... ..., health plan operations, or benefit... ...-time benefit-eligible employees with...ClaimsFull timeTemporary workPart timeWork experience placementLocal areaRemote workFlexible hours- ...W2 only Job Title: Test Analyst Location: Remote Rate: $30/hr.w2 What are the top 3 skills required for this role? 1.PBM 2. Clinical knowledge 3. RxClaims 4. Manual Testing... .... • Knowledge in Health Plan benefit structures. • Experience with SQL and...ClaimsRemote work
- ...Overview The Operations Analyst is responsible for... ...keep medical coverage eligibility, member demographics, and claim/deductible balance... ...between VytlOne’s PBM platform and our client... ...of pharmacy benefit administration, coverage... ...insurance Rx, dental, vision, other...ClaimsTemporary workRemote workFlexible hours
- ...unites the financial, operational, and commercial... ...Trade Operations Analyst will serve as a... ...and rebate claims in accordance with... ...Validate membership eligibility, effective dates,... ...Experience supporting testing and... ...affordable medical benefits + non-medical perks...ClaimsContract workVisa sponsorshipFlexible hours
$21 per hour
...seeking a Pharmacy Adjudication Specialist at our... ...offer a variety of benefits including: Medical... ...pharmacy claims, review claim responses... ...requests from pharmacy operations, providers and/or... ...to claims for eligible patients based on... ...claims resolution, PBM and Medical contracts...ClaimsFull timeTemporary workWork experience placementRelocation packageFlexible hoursShift work- ...team environment. The ideal candidate will have experience with RX claims and a solid understanding of healthcare legislation. Join a... ...team where your contributions will directly impact healthcare operations and improve patient outcomes. This is an exciting opportunity...Claims
- ...Eligibility Analyst III - Remote Full Time Supervisory... ...driving claim adjudication. Responsible for... ...Responsible for testing, monitoring, issue... ...Have to Offer Our benefits package is designed... ...Experience with operational ticketing and... ...operations experience PBM or health plan...ClaimsFull timeWork experience placementLocal areaImmediate startRemote workWeekend work
- ...configuration, condition and operational status of all... ...security clearance with eligibility for access to Sensitive... ...been designated as a Testing Designated Position (TDP... ...checklist for your claimed preference). To determine... ...with a comprehensive benefits package. As a federal...ClaimsFull timeContract workTemporary workPart timeWork experience placementWork at officeWorldwideTrial periodAfternoon shift
$22.5 per hour
...oriented Pharmacy Benefits Verification... ...and prescription claims processing. This... ...Verify insurance eligibility and benefits through... ...to ensure timely adjudication Coordinate with... ...Benefit Management (PBM) services to... ...benefits and healthcare operations Supportive...ClaimsPermanent employmentFull timeTemporary workRemote workMonday to Friday- ...participates in exercises and tests to implement branch, section, element operational requirements.... ...authority categories below are eligible to apply for this job.... .... If you are a veteran claiming veterans' preference,... ...with a comprehensive benefits package. As a federal employee...ClaimsPermanent employmentFull timeContract workPart timeFor contractorsLocal areaImmediate startRelocationOverseasTrial periodAfternoon shift
$19 - $25 per hour
...Biller Billing & Insurance Eligibility Specialist Location: Las... ...insurance verification, and claims management, with a solid understanding... ...insurance eligibility and benefits Calculate and collect... ...Mental Health, ABA, Psychological Testing) Familiarity with Centers...ClaimsHourly payPart timeFlexible hoursAfternoon shift- The State of Indiana seeks a Disability Claims Adjudicator to assess eligibility for Social Security Disability Insurance and Supplemental Security Income... ...Security Administration’s guidelines. Comprehensive benefits include medical plans, paid time off, and retirement contributions...ClaimsExtra income
- ...Business Analyst BA positions are... ...prescription drug benefits. They will... ...technical aspects of claims processing, adjudication, eligibility and enrollment... ..., and reviews test cases related to... .... Operational Monitoring: 5%... ...Benefit Manager (PBM) - Healthcare/PBM...ClaimsContract workFor contractorsWork at officeRemote work
$80k - $95k
...Progyny! We're hiring a Solutions Analyst to be the operational lead for our external eligibility and enrollment vendor... ...systems. Process, Documentation & Testing Author playbooks, SOPs, and other... ...field. 3-5 years in insurance or benefits operations, systems/business...Summer workWork at officeRemote workFlexible hours3 days per week- ...Title:IT Business Analyst (Remote)... ...prescription drug benefits. They will... ...technical aspects of claims processing, adjudication, eligibility and enrollment... ..., and review test cases related... ...necessary. Operational Monitoring:5%... ...Benefit Manager (PBM)...ClaimsFor contractorsWork at officeLocal areaRemote work
- ...RxCompass Claims Operations Analyst Position Overview... ...formatting, accuracy, eligibility, and processing... .... Support testing or validation of... ...claims, PBM operations, specialty... ...to Offer Our Benefits package is designed... ...claims, claims adjudication, claims...ClaimsFull timeWork at officeLocal areaImmediate startRemote workWeekend work
- Benefit Eligibility Specialist for the State of Arizona TeemaGroup Contract In-Office | Tucson, AZ, United States The Opportunity This... ...for conversion. These positions will review unemployment claims, adjudicate them, conduct interviews, use critical thinking and analytical...ClaimsPermanent employmentFull timeContract workWork at office
- ...contract-to-hire position. Eligibility for conversion to direct... .... Senior QNXT Benefit Configuration Analyst Role Overview... ...platform to ensure accurate claims adjudication and regulatory compliance... ...Experience configuring and testing benefits during new...ClaimsContract workRemote workFlexible hours
- ...simple and affordable pharmacy benefit programs to employer groups,... ...including pharmacy insurance claims databases. Skilled in utilizing... ...risk factors associated with PBM contracts and pricing strategies... ...industry standards related to PBM operations and healthcare finance....ClaimsContract workWork experience placementRemote work
- ...currently looking for a Sr. Operations Analyst in United States. This... ...integrity within pharmacy benefit management systems. You will... ...EDI) integrations that keep eligibility, claims, and accumulator data synchronized... ...subject matter expert for PBM file integration processes,...ClaimsRemote jobFull timeTemporary workFlexible hours
$86.8k - $124k
...Advisor Business Analyst - MMIS -... ...Member, Provider, Claims (Medicaid,... ...and operational readiness.... ...Edits, pricing, benefit limits, adjudication logic Plan: Contracts... ...credentialing Member: Eligibility, benefits,... ...Pharmacy: RX benefits, RX... ...Testing Review test cases...ClaimsFull timeRemote workFlexible hours- ...We are currently looking for a Sr. Operations Analyst in the United States. This role... ...data operations within a pharmacy benefit management (PBM) environment, ensuring seamless... ...integration projects that support eligibility, claims, and accumulator data synchronization...ClaimsRemote jobFull timeTemporary workFlexible hours
- ...are currently looking for an Operations Analyst in the United States.... ...of healthcare and pharmacy benefit data across client and third... ...discrepancies that impact eligibility, claims, and accumulator balances.... ...Maintain working knowledge of PBM systems, file integration standards...ClaimsRemote jobFull timeTemporary workWork at officeFlexible hours
$85.06k - $104.37k
...Product Manager, Claim Adjudication, Medicaid/Medicare... ...traditional pharmacy benefit manager (PBM) models. We are committed... ...are implemented and operational in support of an... ...requirements development, and testing Ensure post-... ...and/or Business Analyst experience a plus...ClaimsFull timeRemote workFlexible hours- ...while supporting operational excellence,... ...Group Health Plan claims. Research and... ...documents, Evidence of Benefits (EOBs), eligibility records, and... ...to COB analysts. Deliver training... ...and proper claims adjudication. Ensure adherence... ...in system testing, policy updates,...ClaimsWork experience placementRemote work
$36.32k - $40k
...Health Working Title: OPERATIONS ANALYST II - HELP DESK... ...system quality assurance testing; and coordinate with... ...remote work. The Benefits of Working for the State... ...1, 1962, will not be eligible for hire or promotion... .... Candidates claiming Veterans’ Preference...ClaimsFull timeWork at officeRemote workFlexible hours- ...is seeking a Revenue Cycle Operations Analyst to join the Toledo team. This... ...effectiveness. # Investigates claim denials, underpayments, and... ...thorough and timely testing and verification of revenue... ...our resources in you! Some benefits of working with Harbor include...ClaimsFull time
$61.3k - $73k
...lives, Machinify's AI operating system, combined with... ...Inventory & Quality Analyst (Eligibility) leverages strong knowledge... ..., healthcare claims, eligibility validation... ...practices, Coordination of Benefits and Third‑Party... ...analytical skills to: Test data transfer/flow...ClaimsFor contractorsWork at officeRemote workWork from homeHome officeShift work- ...Benefit Configuration Tester Lehi, UT; Plano, TX This is... ...Pharmacy Benefit Management (PBM) sector by building a next-generation... ...the necessary configuration testing to ensure requirements are... ...understanding of SmithRx claims adjudication system and upstream/...ClaimsHourly payWork experience placementRemote workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to PBM Operations Analyst (Rx claim adjudication, eligibility, benefits, testing) |. Be the first to apply!
Related searches
- business operations analyst United States
- junior operations analyst United States
- customer success operations analyst United States
- operations analyst intern United States
- client operations analyst United States
- business development operations analyst United States
- cyber security operations analyst United States
- operations analyst United States
- ad operations analyst United States
- marketing operations analyst United States





