Benefits Analyst - Remote

*This is a non-HR related role. This role focuses on non- customer facing benefits administration responsibilities**

As a Benefit Administration Analyst, you will be part of an extremely talented team within our Client Benefits department at CerpassRx. You will be responsible for analyzing client requests and performing the necessary benefits coding, collaborating with the Testing and Quality Assurance team members to ensure that the coding is correct, and working closely with our Implementation and Account Management teams to deliver high quality support to our clients.

Responsibilities

· Develops in-depth understanding of and develops ability to create and maintain plan/benefit design rules and limitations to include:

o Adjudication rules

o Clinical rules

o Payment rules

o Client management

o Plan/group management

· Analyze benefit requests and ensure appropriate implementation to claim adjudication system (i.e. copays, accumulations, drug coverage, DAW, formulary, COB, Specialty, Mail Order)

· Work with Implementations and Account Management to implement new and maintain existing benefit plans and client pricing in the claim adjudication system

· Work with Clinical to implement formulary updates in the claim adjudication system

· Develops ability to evaluate claims to identify errors and adjust accordingly

· Researches plan/benefit design options and requirements as required

· Provides consultative feedback to Implementations and Account Management surrounding benefits designs and client requests.

· Perform claim testing to ensure accurate claim adjudication

· Maintain acceptable and appropriate quality levels and production SLA response time

Other Responsibilities

· Develops ability to provide client consultation and facilitate client meetings over the phone and face to face if required

· Develops professional knowledge in clinical programs, prior authorizations, and corresponding claim behavior

· Performs other duties as assigned

· Continued education in the areas of written and verbal communication skills and computer skills

Requirements

· Excellent written and verbal communication skills

· Demonstrated positive interpersonal skills

· Strong organizational skills

· Ability to work independently as well as with team members

· Detail oriented

· Strong Critical Thinking skills

· Must be creative and resourceful, self-starter, highly motivated

· Experience working with internal and external client team members

· Advanced use of Microsoft Office Products

Experience

· 3+ years PBM experience is preferred

· Specific experience with claims adjudication preferred

· High School Diploma or GED Required. Bachelor’s Degree Preferred

Job Type: Full-time

Pay: From $50,000.00 per year

Benefits:

• Flexible spending account
• Health savings account
• Paid time off
• Health insurance
• Professional development assistance
• Dental insurance
• Vision insurance
• 401(k)
• Tuition reimbursement
• Life insurance

Schedule:

• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• PBM: 2 years (Preferred)
• Claims Adjudication: 2 years (Preferred)

Work Location: Remote