Address
Form of work
Salary**NO EXPERIENCE NECESSARY- WE WILL TRAIN**
Do you want a career where you can make a difference? Allegiance is a growing company with hometown values that is looking for dynamic candidates to join the team! A positive, team-oriented environment is provided with opportunities for advancement.
Allegiance offers full-time positions with evenings, weekends, and holidays off and a multi-faceted benefits package.
We pride ourselves in having a reputation for top-notch customer service. Make a difference. Start your career with Allegiance today!
REPORTS TO: Pharmacy Service Team Lead
LOCATION: Allegiance Office or Off-Site
FLSA STATUS: Non-Exempt
POSITION RESPONSIBILITIES:
The Pharmacy Service Team Import Specialist is responsible for claims file data sharing with all groups utilizing a Pharmacy Benefit Manager (PBM). This includes all support functions necessary to provide accurate information with courteous and timely service to all inquiries. Occasional travel maybe required.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
- Responsible for importing PBM files for processing.
- Responsible for following/meeting monthly audit criteria in order to maintain accurate import data for daily/finance files.
- Creates/maintains Pharmacy Import Decision workflows to be posted on Main.
- Creates and ensures Pharmacy Import Checklist is signed off on when implementing new groups/new PBMs.
- Completes voids/negatives in the system if needed and within the timely manner.
- Coordinates special programming needs with Plan Builders.
- Sorts invoices from PBMs; routes to scanning.
- Balances all invoices received from the PBM to match to the claims files.
- Collaborates with Indexing Department to determine best practices for indexing PBM invoices and individual Rx claims.
- Contributes to the daily workflow with regular and punctual attendance.
- Requests individual paid claims reports from PBMs for submission to stop loss carrier; runs check report from claims processing
system to verify payment for stop loss carrier. - Answers telephone calls and emails from PBMs, plan sponsors, plan participants, providers, and internal departments
pertaining to pharmacy benefits, claims inquiries and programming; provides prompt, clear and accurate responses to requests
for information - Ability to update participant data to include new adds and COBRA enrollees as needed daily.
- Ability to assists internal departments by researching information on specific drugs as requested.
- Ability to program accepted plan overrides.
NON-ESSENTIAL JOB FUNCTIONS:
- Performs related or other assigned duties as required or directed
SUPERVISION EXERCISED:
None.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting
80%
Reaching
Some
Standing
10%
Manual Dexterity
High
Walking
10%
Telephone
Yes
Kneeling
Some
Computer Screen
High (visual acuity corrected to 20/30)
Bending
Some
Lifting
up to 30 pounds
JOB SPECIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education:
High school graduation or GED required. College degree and/or training in medical terminology preferred.
Certification(s) Required:
None.
Minimum Experience:
Previous experience with computer software applications is required. Work experience with group health benefits or in the health insurance industry preferred.
Other Qualifications:
- Excellent oral and written communication skills required.
- PC skills, including Windows, Excel, Access, Word, internet navigation, and email applications. PowerPoint preferred. Ability to learn all functions of the claims processing software as is necessary for data entry, research and report generation.
Must be able to adapt to software changes as they occur.
- Accurate data entry and typing skills.
- Knowledge of medical terminology and basic health insurance concepts.
- Excellent listening skills.
- Basic mathematical skills.
- Ability to gain thorough knowledge of pharmacy benefit systems and contracting.
- High level of interpersonal skills to work effectively with others.
- Ability to organize and recall large amounts of detailed information.
- Ability to project a professional image and positive attitude in any work environment.
- Ability to comply with privacy and confidentiality standards.
- Ability to be flexible, work under pressure and meet deadlines.
- Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
- Ability to take initiative and work independently.
- Ability to operate typical office equipment.
Working knowledge of general office procedures.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: recruiting@askallegiance.com for support.
