Pharmacy Benefits Analyst

2 weeks ago

Southfield, Michigan, United States TekWissen LLC Full time
Job DescriptionOverview: TekWissen Group is a leading provider of workforce management solutions across the USA and internationally. Our client operates within the health insurance sector, offering a variety of health care coverage options, including individual and family plans, as well as dental and vision insurance. Position: Healthcare Data AnalystWork Location: RemoteContract Duration: 12 MonthsJob Type: ContractDepartment: Medicare Pharmacy Operations Engagement Overview:
  • The Healthcare Data Analyst role is essential for supporting Medicare Advantage PPO, HMO, and PDP plans in achieving compliance with CMS regulations regarding PBM oversight, reporting, and benefit configuration and testing.
  • Additional relevant skills may be necessary to fulfill the responsibilities of this position. The indicated hourly rate is an estimate and may not represent the final agreed-upon compensation.
Key Responsibilities:
  • Enhance workflows and business processes to elevate customer service, reduce operational expenses, and enhance overall quality.
  • Support Customer Service by addressing inquiries and providing clear, concise responses.
  • Assist in CMS and internal audits related to data integrity.
  • Identify and analyze business challenges, developing procedures to address these issues.
  • Lead projects effectively to achieve desired outcomes.
  • Communicate project results to corporate stakeholders.
  • Recommend and aid in the implementation of standardized policies and procedures.
  • Ensure ongoing communication, implementation, and monitoring of corporate compliance.
  • Participate in systems testing, develop controls, and suggest improvements for updated processes.
  • Provide assistance to both internal and external personnel by answering questions and offering training.
  • Foster and maintain effective working relationships with clients.
  • Engage in discussions within groups or committees.
Education Requirements:
  • A Bachelor's degree in a relevant field is preferred.
  • A combination of education and experience may be accepted in lieu of a degree.
  • Commitment to continuous learning as defined by the company's educational philosophy is required.
Experience Requirements:
  • A minimum of four (4) years of experience in a related field is required, preferably within health plans or PBM.
  • Proficiency in Microsoft Office applications, including Excel, Word, and Outlook.
  • Strong data analysis and problem-solving skills are essential.
  • Experience with spreadsheets and/or databases.
  • Familiarity with resolving eligibility and pharmacy claims issues.
  • Experience in timely responses to CMS inquiries regarding pharmacy claims.
Required Skills/Knowledge/Abilities:
  • Understanding of pharmacy claim processing and Medicare regulations pertaining to Part D products.
  • Strong organizational skills with the ability to prioritize multiple tasks effectively.
  • Willingness to learn and take on additional responsibilities as needed.
  • Experience with PBM systems and tools.
  • Ability to comprehend inquiries from external sources and provide accurate, timely responses.
  • Proven experience in operational analysis, data analysis, and problem resolution.
  • Strong analytical, organizational, planning, and problem-solving skills.
  • Familiarity with business operations, products, programs, and corporate structure.
  • Ability to plan, organize, direct, and manage projects.
  • Excellent written and verbal communication skills.
  • Capability to lead and contribute to process improvement initiatives.
  • Ability to interpret documents such as data flows, process flows, and technical diagrams.
  • Proficient in writing routine reports and correspondence.
  • Ability to effectively communicate before groups of clients or team members.
  • Ability to apply common sense in executing instructions provided in various formats.
  • Ability to address problems involving multiple variables in standardized situations.
  • Adhere to corporate and departmental policies and procedures.
TekWissen Group is an equal opportunity employer committed to workforce diversity.

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