Benefit Plan Configuration Advisor

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 Advisor

Job Description Summary

Responsible for providing subject matter expertise on interpreting complex benefit configuration plan designs for new business installations and maintenance for existing business. Serves as a liaison in defining best configuration/testing practices among multiple lines of business. Supports departmental management team by providing expertise in the development of Prime Therapeutics best practices for client installations, maintenance of business and program offerings. Coordination of training and documentation of best practices across multiple lines of business.

Job Description

• Manages complex clients/programs from a coding, testing and validation perspective.
• Provides consultation to internal partners to ensure intent is accurately captured and implemented for client benefit requests.
• Collaborates internally to determine best operational approach for new business installations and benefit adjustments.
• 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).
• Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specifications and data flow from which programs are developed and coded.
• Assists in developing departmental policies and procedures and trains peers on the benefits teams.
• Demonstrates an in-depth working knowledge of the benefits department`s workflow and the impact to other departments.
• Participates in and leads internal calls with clients to understand the intent of requested benefit changes.
• Identifies, analyzes and presents to leadership creative solutions for process improvement activities regarding benefit configuration.
• Manages project plans and performs analysis to ensure the initiative deadlines are met.
• Facilitates conversations within the team to define client intent and program setup.
• Other duties as assigned.

Responsibilities

• 5+ years of experience in benefit plan configuration/analysis.
• Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
• Ability to understand the system's functionality and business policies.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to prioritize all work deliverables effectively and independently.
• Excellent time management, organizational and written/verbal communication skills.

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 $60,800.00 - $97,280.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

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.