Remote PBM Operations Analyst, Data Operations

Summary

Join Rightway as a PBM Operations Analyst and contribute to designing, building, and operating a new-to-the-world pharmacy benefit management (PBM) model. This role will be responsible for the configuration, testing, and maintenance of benefits and related claims adjudication rules within the claim platform.

Requirements

• Bachelor’s degree preferred
• Relevant experience considered for exceptional candidates
• Pharmacy Technician or related experience highly desirable
• 1-3 years of PBM experience in claims or benefit configuration

Responsibilities

• Support the execution of all eligibility and accumulator operations
• Serve as day-to-day contact for all eligibility and accumulator needs
• Collaborates with technology, account management, benefit administration, and other internal stakeholders to ensure that eligibility and accumulator functions are implemented and operating in accordance with requirements
• Oversee all downstream vendor feeds (i.e. ID card fulfillment), third party integrations (i.e. health plans, TPAs) and ensures all deliverables are met timely and troubleshoots issues
• Configures benefits into the claim adjudication platform, including benefit inclusions/exclusions copay, accumulator, and other benefit parameters
• Develops and executes on test scenarios to ensure accuracy of benefit setup both at initial setup and conducts ongoing monitoring and regression testing. Works to correct all identified defects
• Performs research and troubleshoots inquiries or issues related to claims adjudication, accumulators, and eligibility
• Ensures all documentation regarding setup and internal controls is always up to date