Pharmacy Benefit & Reporting Specialist

JOB SUMMARY:

Allegiant Care is now hiring a personable, hardworking, professional Pharmacy Benefit Reporting Analyst with a strong work ethic to join our dynamic team in Manchester, NH.

The ideal candidate will have reporting, accounting, bookkeeping, pharmacy, or healthcare related experience and can transform raw data into meaningful information, derive valuable insights, and produce reports in excel for ten union Funds, auditors, and legal counsel utilizing historical and current data. As a Pharmacy Benefit Reporting Analyst, you are also responsible for a wide variety of Pharmacy Benefit related tasks, including compiling, and summarizing clinical data for review by our Clinical Pharmacist, prior authorizations, and appeals. You will also be responsible for answering incoming calls from our members, healthcare professionals, pharmacies, and union Funds.

At Allegiant Rx, our members are at the core of everything we do. The top priority of our Pharmacy Benefits team is to assist and advocate for our members and to ensure that their experience with Allegiant Rx leaves a lasting positive impression. As a Pharmacy Benefit Reporting Analyst, you are responsible producing reports, maintaining spreadsheets, and data files and for delivering high quality, friendly, professional, timely and accurate responses to members’ questions about their Pharmacy Benefits. You will also assist pharmacies with claims adjudication and communicate with providers offices. We take our commitment to our members seriously and this position is essential to the organization’s success as a trusted benefit provider.

Primary Job Responsibilities:

• Prepare monthly and custom report requests for ten union Funds
• Prepare reports for auditors
• Prepare reports for consultants
• Prepare eligibility reports
• Prepare stop loss reports
• Review billing, rebate, and administrative fee invoices
• Review prior authorization reports
• Maintain Fund workbooks each billing cycle
• Compile, and summarize clinical data for review by our Clinical Pharmacist
• Generate, format, and summarize standard claims data extracts using reporting tools and Microsoft Excel
• Download clinical data from our pharmacy partner’s database
• Assist retail pharmacies with claims adjudication
• Effectively resolve questions and concerns in a considerate, professional, and timely manner using a variety of communication channels (phone, email, web, etc.)
• Interpret and explain prescription, deductible, out of pocket benefits to members
• Take full ownership of any follow-up required to thoroughly address members’ questions or concerns, such as researching claim-related information with third-party vendors
• Develop and maintain an effective tracking system to ensure that nothing falls through the cracks
• Document every member interaction in benefit administration system to ensure the member’s record is up to date with all relevant information
• Master the details of the various benefit plans to ensure you can provide timely and accurate information to member inquiries
• Spot any trends in member issues and flag for the rest of the team

Requirements and Skills (About you and the skills you will need to be successful in this job)

• You possess intermediate to advanced Excel skills
• Reporting, bookkeeping, accounting experience
• Data and detail driven
• Organized
• You possess strong organizational and time-management skills
• Customer Service Oriented
• Pharmacy, PBM, Healthcare experience
• You excel in a fast-paced environment
• You excel learning new tasks
• Professional and pleasant phone etiquette
• You care deeply, genuinely, and passionately about customer support and the role it plays in making a member-focused team successful
• You are skilled at composing thoughtful, articulate, thorough and personalized responses to questions
• You can manage frequent interruptions and respond appropriately to unexpected situations with poise and without frustration
• You are naturally calm and professional under pressure, and you excel at deescalating a challenging caller
• You excel at the subtle nuances of effective communication such as listening to understand the full scope of what is being asked. Recognizing, and responding to unspoken needs, clearly conveying information, and patiently repeating or reframing when the recipient does not understand
• You have good mastery of common Microsoft products such as Word, Excel and Outlook and you can quickly learn new software systems
• You are confident and extremely comfortable using common office equipment such as phones, copiers, fax machines, printers

Education and Experience:

• Experience in Accounting, reporting, bookkeeping, pharmacy, medical or healthcare insurance strongly desired, but we will train the right candidate
• A high school diploma or equivalent required. Associate or bachelor’s Degree preferred
• 3 years of customer service experience in a service-based organization required

About Allegiant Care:

Allegiant Care is a Taft-Hartley multiemployer health and welfare fund that provides health benefits to over 18,000 Teamsters Union members and their families. Allegiant Rx, a division of Allegiant Care, is the Pharmacy Benefit manager (PBM) for ten independent health and welfare funds covering over 70,000 lives.

Please include a cover letter with your resume.

No phone calls please.

Job Type: Full-time

Pay: $50,000.00 - $65,000.00 per year

Benefits:

• Pension – Vested after 5 years
• Employer Paid Health insurance
• Employer Paid Dental insurance
• Employer Paid Vision insurance
• 401(k)
• 401(k) matching
• Paid time off

Working Conditions:

• Office environment
• Fast paced, moderate call volume

 Allegiant Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by law.