Pharmacy Benefit Analyst, Medicare

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Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. Forbes ranked Premera among America’s 2022 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

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About the role of Pharmacy Benefits Analyst:

The Pharmacy Benefit Analyst acts as technical subject matter expert for the Pharmacy and Product Configuration teams on Pharmacy Benefit Manager (PBM) benefit coding and program, providing research, analysis, and support for wide range of processes, systems and workload issues. The Analyst plays a key role in: ensuring that pharmacy programming has been set-up accurately by the PBM vendor and provides quality assurance and testing related to claim adjudication and plan set-up; Providing oversight of all PBM data interfaces; Responding to inquiries and, collaborates with internal and external business partners to analyze and facilitate alternatives and recommendations for standard and custom PBM benefit configuration; Utilizing knowledge of Premera systems and processes as well as state and federal regulations and guidelines to identify risks and escalate possible PBM benefit configuration issues.

What you’ll do:

• Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.
• Provide oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct.
• Provide technical support and partners with PBM vendor, and Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding, interpretation of pharmacy benefits and new pharmacy product builds.
• Develop training content and provide instruction to staff both 1:1 and in classroom setting. Work collaboratively with training staff in developing training programs.
• Research and provide direction to team on complex PBM benefit coding and compliance issues. Provide input to PBM vendor, IT and teams on custom benefit requests and make recommendations for alternative approaches. Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing.
• Monitor delivery and tracking for wide range of inquiries, activities and workload within team providing direction to team members and on-going status reports to leadership.
• Other duties as assigned.
• Collaborate with cross functional Premera teams, including sales, system configuration, claims, contract services, group set-up, membership and billing, customer service, on feasibility and processing requirements for new and custom products and services, to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues.
• Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been done appropriately and reviews system generated outputs to validate outcomes.
• Create, maintain and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work to mitigate any risks. Develop processes and procedures for new and changing requirements.

What you’ll bring:

• Ability to learn and effectively understand/utilize new concepts and functions quickly.
• Bachelor’s degree. (Preferred)
• Washington pharmacy technician license. (Preferred)
• Must have Medicare Part D Benefit Experience
• Demonstrated proficiency in Microsoft Word, Excel, PowerPoint and Outlook.
• Bachelor’s degree or four years equivalent experience. (Required)
• Demonstrated ability to effectively manage and prioritize a high volume of work effectively.
• Ability to organize and multi-task while maintaining strong attention to detail to ensure accuracy.
• Previous experience troubleshooting production issues within claims or customer information systems or databases.
• Experience in proactively applying analytical, problem solving and / or technical abilities to daily responsibilities.
• Strong written and verbal communication skills, and ability to experience, establish and maintain effective relationships.
• Demonstrated ability to independently analyze pharmacy product designs and develop an alternative configuration approach to achieve desired outcome.
• Ability to work independently and as a member of a team and influence others to resolve issues.
• Previous experience in Premera product configuration. (Preferred)
• In-depth knowledge of pharmacy benefit coding.
• Three years PBM technical experience in benefit coding or claims adjudication or related area which includes at least one year experience in PBM benefit configuration or equivalent. (Required)

#LI – RS1

#LI - Remote

What We Offer

• Generous Paid Time Off to reenergize
• Wellness incentives, onsite services, a discount program and more
• Medical, vision and dental coverage
• Free parking
• Tuition assistance for undergraduate and graduate degrees
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range:

$65,500.00 - $105,800.00

National Plus Salary Range:

$70,300.00 - $119,500.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.