Job Summary
A healthcare company is filling a position for a Remote Pharmacy Benefit Plan Administrator II.
Individual must be able to fulfill the following responsibilities:
- Analyze new business requirements for benefit designs & changes in order to establish the appropriate solution for our stakeholders
- Perform accurate administration of plan benefits coding changes & new plan benefit designs into the appropriate adjudication system
- Assist in ongoing development & improvement of audit process to include; peer testing solutions & partnering with QA team resources
Skills and Requirements Include:
- Strong working knowledge of Microsoft Office suite, specifically Word and Excel, including running queries and macros.. .. .
- Experience in interpreting and understanding codes/benefits
- Experience with claims processing systems and configuring codes/benefits to optimize auto-adjudication
- Ability to identify and resolve process and/or systems issues
- Strong sense of urgency leading to the timely completion of all projects, training and assignments
- Familiarity with government regulations with ability to operationalize & understand how various aspects of regulation is related
