Position:  Pharmacists (Benefit Analyst)
Job Description:

□ Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of pharmacy claim adjudication system
□ Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system
□ Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system
□ Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system
□ Ensure timely communication of any issues and/or information needed to complete a plan request
□ Develop client specific implementation plans and manage implementation processes in accordance with department protocol
□ Run queries out of the adjudication system to secure all necessary information to implement plan requests
□ Develop and run macros to implement plan requests
□ Perform claim testing to ensure accurate claim adjudication
□ Maintain acceptable and appropriate quality levels and production turn-around time
□ Adhere to all documentation standards within the department
□ Assist with the development of process improvements for the department
□ Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal department
□ Participate in team meetings
□ May be assigned to work on special projects and business initiatives

Skills

□ Microsoft Office proficiency Word and Excel, specifically Advanced Excel skills -- must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting
□ Strong written and verbal skills
□ Detail-oriented
□ Superior organization skills
□ Ability to work on multiple project simultaneously
□ Excellent analytical skills

Qualifications

□ Certified pharmacy technician preferred
□ Degree in B.Pharma / M.Pharma / M.Sc in Biotechnology / Recognized Nursing course

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