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Pharmacy Benefit Management Integration Specialist
2 months ago
Position Overview
Role Summary: The PBM Integration Analyst plays a crucial role within the ProAct IT division, reporting directly to the Partner Integration Manager. This position is tasked with the configuration, testing, and ongoing maintenance of partner integrations, as well as the analysis and remediation of claim records.
Key Responsibilities:
- Facilitate the execution of all accumulator operations and interfaces from the initial implementation phase through to continuous operational support.
- Engage with both new and existing partners to develop and manage ProAct's core business processes related to accumulators, which includes collaboration with various Third Party Administrators (TPAs), electronic file transmissions, and reporting requirements.
- Collaborate with cross-functional teams to systematically incorporate and support new partners within established accumulator business processes.
- Work alongside development teams to validate custom programming associated with the processing and automation of accumulator data.
- Conduct thorough analysis of business data to identify root causes of data discrepancies as they arise.
- Communicate requirements and processes to both internal and external technical and business stakeholders using various formats such as use cases, logical diagrams, and flow charts.
- Complete all mandatory and regulatory training programs as required.
- Perform additional duties as assigned by management.
Qualifications:
Education: A Bachelor's degree is preferred; however, relevant experience may be considered for exceptional candidates.
Experience:
- Experience as a Pharmacy Technician or in a related field is highly desirable.
- 1-3 years of experience in Pharmacy Benefit Management (PBM) within claims or insurance operations.
Special Employment Conditions:
- Successful completion of a drug test.
- Ongoing monitoring for exclusions and sanctions.
- Compliance with any additional eligibility requirements specific to the position.
- Agreement to the Elevated Privileges Acceptable User Agreement.
Required Skills:
- Strong understanding of claims system behavior, file feeds, and elements pertinent to accumulator data processing.
- Ability to identify data quality issues and implement corrective measures.
- Propose opportunities and recommend enhancements to IT systems to ensure optimal performance.
- Coordinate activities and communications with internal teams and business partners effectively.
- Capable of managing multiple tasks and adapting to changing priorities in a dynamic environment.
- Excellent verbal and written communication skills.
- Self-driven with a strong customer service orientation and problem-solving skills.
- Commitment to adhering to system and industry security protocols.
Compensation:
Compensation will be determined based on a comprehensive evaluation of relevant skills, experience, and educational background.
ProAct - PBM adheres to all applicable local, state, and federal regulations regarding minimum wage requirements.
