Senior Benefits Configuration Tester

Posted 16 Days Ago
Be an Early Applicant
Hiring Remotely in USA
Remote
Senior level
Pharmaceutical
The Role
Design and execute complex test plans for benefits configuration, validate advanced logic (prior authorization, accumulators), document defects, liaise with Benefit Operations, and mentor junior testers to ensure accurate claims adjudication and plan design implementations.
Summary Generated by Built In

Who we are: 

SmithRx is a rapidly growing, venture-backed Health-Tech company.  Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting-edge technology, innovative cost-saving tools, and best-in-class customer service.  With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country. 

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our Company values of: 

  • Integrity: Do the right thing. Especially when it’s hard.
  • Courage: Embrace the challenge.
  • Together: Build bridges and lift up your colleagues 

Job Summary: 

As a Senior Benefits Configuration Tester, you have a substantial understanding of benefit design and apply your skills to complete a wide range of complex testing tasks. You will be responsible for submitting advanced test cases to validate the accuracy of benefit configuration setups, ensuring requirements are met for implementations and maintenance changes. Moving beyond routine execution, you will support junior team members, troubleshoot moderately difficult discrepancies, and serve as a vital liaison between the testing team and Benefit Operations seniors.

What will you do: 

  • Organize testing suites, create test plans, and submit moderately difficult test cases to validate the accuracy of complex benefit configuration setups.
  • Serve as a key liaison with senior members of the Benefit Operations team, actively communicating to resolve configuration discrepancies, clarify plan designs, and report actionable insights back to the testing team.
  • Provide support, guidance, and peer review for junior team members to ensure testing accuracy, helping them understand SmithRx claims adjudication systems and upstream/downstream processes.
  • Handle Advanced Logic Validation such as Clinical/Prior Authorization and Financial Accumulators. Ensuring patient out-of-pocket maximums and cost-shares remain accurate.
  • Document detailed defect reports for issues uncovered during testing and assist in the development of process improvements focusing on efficiency and accuracy.

What will you bring to SmithRx: 

  • Minimum of 2 - 4 years of related experience in benefits configuration or testing in healthcare. PBM or managed care experience is preferred but not required.
  • Associate degree or equivalent work experience is required.
  • Strong understanding of benefit design standards, including HIPAA, NCPDP, and SmithRx internal business standards, alongside moderate skills in Microsoft Excel.
  • Ability to work with little instruction on daily work, relying on general instructions only for newly introduced assignments.
  • Strong critical thinking skills, such as analyzing data, drawing logical conclusions, and applying smart solutions to moderately difficult situations.
  • Communicate effectively (written, verbal/presentation, and active listening) to successfully act as a liaison and collaborate cross-functionally.

 What SmithRx Offers You:

  • Highly competitive wellness benefits including Medical, Pharmacy, Dental and Vision Insurance. SmithRx pays up to 90% for you and your family.
  • Fully paid Life insurance and Disability benefits
  • 3 weeks PTO
  • 401(k) Retirement Savings Program
  • Flexible Spending Benefits
  • Generous Paid Parental Leave benefits
  • Professional development, training and career growth opportunities
  • Well-stocked kitchen

Compensation & Benefits

  • Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
  • Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).

Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.

Skills Required

  • 2-4 years of related experience in benefits configuration or testing in healthcare
  • Associate degree or equivalent work experience
  • Strong understanding of benefit design standards, including HIPAA and NCPDP
  • Moderate skills in Microsoft Excel
  • Ability to work with little instruction on routine assignments
  • Strong critical thinking and data analysis skills
  • Effective written and verbal communication and active listening for cross-functional liaison
  • PBM or managed care experience
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The Company
HQ: San Francisco, CA
46 Employees
Year Founded: 2016

What We Do

SmithRx is committed to providing a straightforward approach to reducing drug costs and improving health outcomes. We understand that reducing pharmacy costs is top of mind for us all. We utilize cloud technologies to deliver the most streamlined and cost-effective PBM solution: one that is modularized and can be tailored to meet individual needs. Our compelling value proposition can be summarized simply as follows: - 100% Pass-through Pricing & Lowest Total Costs - The Most Advanced Cloud PBM - Best Health Outcomes

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