Benefits Configuration Analyst

at  Pharmacy Data Management Inc

PDMI is looking for a Benefits Configuration Analyst to join our team! This role requires full knowledge of product-specific plan designs and benefit structures across product lines related to their specific product designation. The Benefits Configuration Analyst must understand the specific products within their control and is responsible for the daily operations that support those products amongst the Client Success teams.
Since 1984, PDMI has provided pharmacy data processing and other flexible, scalable solutions to help our clients meet their business objectives. We offer transparent, pass-through pharmacy processing and other services for private label Pharmacy Benefit Managers (PBMs), vertically integrated health plans and hospital systems. In addition to Pharmacy Benefit Administrative Services, we offer 340B Administration, Hospice and Long-Term Care Services.

WORK & EDUCATION EXPERIENCE REQUIREMENTS:

• Minimum four-year college degree preferred or equivalent industry (i.e., healthcare or insurance) experience
• Must have prior experience with benefits and compiling analytical data and reports
• Demonstrated customer service skills
• Background encompassing electronic claims processing preferred

• Provides analysis and support for implementing new client business and ongoing maintenance of existing client business related to benefit design changes.
• Provides analysis, interpretation, integration, and business decisions with regards to system configuration.
• Develops and maintains knowledge of both the technical and operational sides of the business utilizing PDMI’s proprietary claims adjudication system and any other applications, including system upgrades and enhancements.
• Analyzes and implements requests for system configuration with a high degree of accuracy.
• Maintains documentation that validates system configuration.
• Ensures the accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.
• Works closely with internal partners to support and meet client needs for specific products and projects related to claims adjudication, reporting, accumulators, and eligibility.
• Actively engages in project teams and makes recommendations regarding process improvements and other business initiatives.
• Develops, updates, and maintains departmental procedures surrounding specific product lines.
• Shares knowledge and mentors colleagues in specific product line areas to enhance company-wide knowledge of products and services.
• Resolves issues before escalation path transitions outside of department.
• Performs quality assurance peer reviews on system configurations with a high degree of accuracy consistent with department work standards.
• Contributes towards departmental performance by maintaining service level guarantees and achieving individual performance goals around accuracy and timeliness.
• Actively engages in team meetings and provides input for project/issue resolution.
• 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).
• Attends educational summits and/or conferences related to specific product lines.