ShiftCode Analytics, Inc. ยท 2 days ago
PBM prescription claim Analyst - BCBS of Arizona
Phoenix, AZ
Full-time
Onsite
Mid Level
3+ years expShiftCode Analytics, Inc. is seeking a PBM Prescription Claim Analyst for BCBS of Arizona. The role involves analyzing PBM prescription claims for quality and accuracy, supporting customers with medication benefit information, and improving departmental performance standards.
AnalyticsConsultingInformation Technology
No H1B
Responsibilities
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
Qualification
Required
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
Preferred
3-4 years of experience with Rx claims or PBM (Pharmacy Benefit Management)
Background in medical claims or related field
Strong Excel or Excel-like tool proficiency
VLOOKUPs
Filtering and updating spreadsheets
Using basic formulas in spreadsheets
Comfortable handling large datasets quickly and accurately
Data entry experience with an analytical mindset
Experience in Rx claim/PBM work
Company
ShiftCode Analytics, Inc.
ShiftCode Analytics Inc is a Tampa, FL based firm formed with one sole purpose of delivering best and quick services to its clients nationwide.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase