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PBM prescription claim Analyst - BCBS of ArizonaShiftCode Analytics • Phoenix, AZ, United States
PBM prescription claim Analyst - BCBS of Arizona

PBM prescription claim Analyst - BCBS of Arizona

ShiftCode Analytics • Phoenix, AZ, United States
1 day ago
Job type
  • Full-time
Job description

Job Title

Interview: Onsite Visa: USC and GC Hybrid: Phoenix, AZ (need local) JD:

Job Description:

  • Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
  • Support internal and external customers with information on benefits applicable to medication claims
  • Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
  • Communicate recommendations in regard to medication claim processing and benefit decisions.
  • Monitor and investigate reported plan set up system issues
  • Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
  • Resolve escalated member issues
  • Research & provide recommendations for accumulations issues
  • Logs all benefit setup issues on error tracking reports

Ideal Candidate Profile Experience:

  • Highly preferred: 3-4 years of experience with Rx claims or PBM (Pharmacy Benefit Management)
  • Background in medical claims or related field

Technical Skills:

  • Strong Excel or Excel-like tool proficiency
  • VLOOKUPs
  • Filtering and updating spreadsheets
  • Using basic formulas in spreadsheets
  • Comfortable handling large datasets quickly and accurately

Nice to Have:

  • Data entry experience with an analytical mindset
  • Experience in Rx claim/PBM work
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PBM prescription claim Analyst - BCBS of Arizona • Phoenix, AZ, United States

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