Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Benefit Plan Configuration Analyst/CAPS exp required - REMOTE
Job Description Summary
This position specializes in the analysis and application of intermediate level benefit plan design requirements. A successful Analyst will ensure a high level of quality and accuracy through benefit configuration, test execution and validation efforts while serving as a subject matter expert on benefits and claim adjudication system coding setup.
Job Description
- Analyzes new business requirements for benefit design changes to establish the appropriate solution.
- Complies with standards set forth regarding benefit design and configuration including but not limited to Health Insurance Portability and Accountability Act of 1996 (HIPAA) and National Council for Prescription Drug Programs (NCPDP).
- Maintains technical documentation based on standard operating procedures.
- Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specification and data flow from which programs are developed and coded.
- Actively participates in and contributes to daily communications, team meetings and project/issue resolution.
- Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
- Maintains customer documentation that validates configuration.
- Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.
- Completes deliverables independently and within an agile team setting.
- Other duties as assigned.
Responsibilities
- Up to 2 years of experience in benefit plan configuration/analysis.
- Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
- This role requires strong attention to detail, critical thinking and analytical skills
- Strong working knowledge of Microsoft Office suite, specifically Word and Excel, including running queries and macros.
- Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
- 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.
Work Experience
Work Experience - Required:
Benefit Plan Configuration
Work Experience - Preferred:
Education
Education - Required:
A Combination of Education and Work Experience May Be Considered., Bachelors
Education - Preferred:
Certifications
Certifications - Required:
Certifications - Preferred:
Potential pay for this position ranges from $43,190.00 - $64,770.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Positions will be posted for a minimum of five consecutive workdays.
What We Do
Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years.
In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 28+ million members throughout the US.
In addition to core PBM services, we work closely with our clients to implement the right benefit design, clinical and specialty programs, formulary and networks. A few key products:
• NetResults™
• Specialty Drug Management
• Best in Care™
• GuidedHealth®
• Advanced Fraud, Waste and Abuse: Member and Prescriber Investigations
• Prime Analytics™
• CareCentered Contracting™Controlled Substance Management Program
Join us!
Prime is always looking for smart, purposeful people to join our team. We’re growing fast which means there are plenty of opportunities to advance and grow in your career.
At the same time, Prime supports flexibility and offers generous PTO so you can enjoy an enviable work/life balance. We’re a privately held company -big enough to make a difference and small enough for you to have an impact.
Follow Prime on LinkedIn to learn more.