PBM Benefit Analyst - Premera Blue Cross
Mountlake Terrace, WA 98043
About the Job
**Join Our Team: Do Meaningful Work and Improve People's Lives**
Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America's 2023 Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) and America's 2023 Best Employers By State (https://www.forbes.com/lists/best-employers-by-state/?sh=21c7c3d1983b) .
Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com .
As a **Pharmacy Benefit Analyst** , you will act as the technical subject matter expert for the Pharmacy and Product Configuration teams on the Pharmacy Benefit Manager (PBM) benefit coding and program, providing research, analysis, and support for a wide range of processes, systems, and workload issues. You will ensure that pharmacy programming has been set-up accurately by the PBM vendor and provide quality assurance and testing related to claim adjudication and plan set-up. You will provide oversight of all PBM data interfaces, respond to inquiries, and collaborate with internal and external business partners to analyze and facilitate alternatives and recommendations for standard and custom PBM benefit configuration.
**This is a virtual/telecommuter position, working from home.**
**What you'll do:**
+ Provide technical support and partner with PBM vendor and Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding. Interpret pharmacy benefits and new pharmacy product builds.
+ Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been done appropriately and review system generated outputs to validate outcomes.
+ Provide oversight of all PBM data interfaces by ensuring control points are in place to confirm delivery and receipt of files, accuracy of those files, and that mapping of data fields is correct.
+ Research and provide direction to team on complex PBM benefit coding and compliance issues. Provide input to PBM vendor, IT, and teams on custom benefit requests and make recommendations for alternative approaches. Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing.
+ Collaborate with cross functional Premera teams including sales, system configuration, claims, contract services, group set-up, membership and billing, and customer service on feasibility and processing requirements for new and custom products and services to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues.
+ Create, maintain, and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work to mitigate any risks. Develop processes and procedures for new and changing requirements.
+ Develop training content and provide instruction to staff both 1:1 and in classroom settings. Work collaboratively with training staff in developing training programs.
+ Monitor delivery and tracking for a wide range of inquiries, activities, and workload within team, providing direction to team members and on-going status reports to leadership.
+ Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.
**What you'll bring:**
+ Bachelor's Degree or (4) years of equivalent experience. **(Required)**
+ (3) years of PBM technical experience in benefit coding, claims adjudication, or related area which includes at least (1) year of experience in PBM benefit configuration or equivalent. **(Required)**
+ Previous experience in Premera product configuration preferred.
+ Previous experience troubleshooting production issues within claims or customer information systems or databases preferred.
+ Medicare Part D Benefit experience preferred.
+ In-depth knowledge of pharmacy benefit coding.
+ Demonstrated ability to independently analyze pharmacy product designs and develop an alternative configuration approach to achieve desired outcome.
+ Demonstrated proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
**What we offer**
+ Medical, vision and dental coverage
+ Life and disability insurance
+ Retirement programs (401K employer match and pension plan)
+ Wellness incentives, onsite services, a discount program and more
+ Tuition assistance for undergraduate and graduate degrees
+ Generous Paid Time Off to reenergize
+ Free parking
**Equal employment** **opportunity/affirmative** **action:**
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
**Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin _._
The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.
**National Salary Range:**
$67,800.00 - $108,500.00
**National Plus Salary Range:**
$72,700.00 - $123,600.00
_*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._
At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.
Source : Premera Blue Cross