Benefit Setup Specialist

PURPOSE OF THE ROLE

The Benefit Setup Specialist will be responsible for reviewing, analyzing, modifying, and testing the adjudication system as it pertains to benefit plan design. This position will work closely with various departments of the Script Care Ltd. organization; including but not limited to, Platform Management, Quality Assurance and Operations. The role requires a strong technical aptitude, as well as robust analytical and investigational problem- solving skills. The Benefit Setup Specialist will report directly to the Director of Platform Management.

KEY TASKS & RESPONSIBILITIES

• Create, test, and maintain group and plan information such as additions, modifications, and terms in the adjudication system. Review and report any discrepancies.
• Update pricing, drug lists, benefit lists, pharmacy networks and other items that affect plan benefits. Review and report any discrepancies.
• Assist all departments with questions and troubleshoot issues as they relate to plan setup, rejections, overrides, etc.
• Create and run various reports, as requested
• Work with Director of Platform Management to analyze internal and client programming requests and upon determination, recommend system enhancements
• Conduct quality assurance reviews and assist with audits on any new or updated benefit designs in the system. Review and report discrepancies
• Assist with full regression testing and the documentation of results for new adjudication releases, as they pertain to system capabilities. Review and report any discrepancies
• Proactively identify setup issues and escalate to the appropriate party for immediate review and resolution
• Able to manage and support multiple projects, tasks, initiatives, and deliverables simultaneously while paying close attention to deadlines
• Interpret, comprehend, and deploy necessary plan benefit changes in the system under various time constraints
• Must be a self-starter and able to work independently

QUALIFICATIONS

• Bachelor’s Degree preferred
• Must be able to think analytically and methodically to solve complex problems
• Must be able to multi-task
• Strong organizational skills
• Strong communication skills
• Experience in a Pharmacy Benefit Manager environment a plus

PROFESSIONAL SKILLS, EXPERIENCE & COMPETENCIES

• Proficient with the full Microsoft Office suite with a willing and eagerness to learn new software programs as needed
• Excellent written and verbal communication skills, with the ability to successfully communicate with individuals from various levels of the organization
• Willing to travel as needed
• Able to provide insight and individual analyses on issues pertaining to benefit plan design and platform management
• Must be organized, possess a strong attention to detail and have exceptional follow-through skills
• Demonstrated ability to think independently and execute on decisions
• Willingness to occasionally work outside of normal business hours pursuant to industry demands