Rx Claims Configuration Specialist
Job Summary
Managing the adjudication process for clients, the remote contract Rx Claims Configuration Specialist will be responsible for mapping rules between software platforms, troubleshooting claims tickets, and ensuring compliance with established procedures.
Key Responsibilities
- Manages assigned tickets in a ticketing system and resolves adjudication queue issues promptly
- Adjudicates benefits on multiple software platforms following Standard Operating Procedures (SOP) and Desktop Procedures (DTP)
- Communicates with various teams to clarify benefit designs and assists with client migrations from external to internal claims processors
Required Qualifications
- 2+ years of experience in a Pharmacy Benefit Manager (PBM) environment using a claims processor
- Intermediate or advanced proficiency with MS Excel, Word, PowerPoint, and Outlook
- High school diploma or equivalent
- Experience in benefit design or configuration
- Ability to adapt to and learn new technologies and skills
Complete Job Description
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