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ShiftCode Analytics, Inc. · 1 day ago

PBM prescription claim Analyst - BCBS of Arizona

Phoenix, AZ

Full-time

Onsite

Mid Level

3+ years exp

ShiftCode Analytics, Inc. is a company focused on providing analytical solutions, and they are seeking a PBM Prescription Claim Analyst. The role involves analyzing PBM prescription claims for quality and accuracy, supporting customers with benefit information, and participating in quality initiatives to improve 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