Benefit Configuration Specialist

Company: Aerotek
Location: San Diego
Posted on: April 9, 2021

Job Description:

Description:Job Description: -Applies pharmacy, formulary, and benefit configuration to effectuate change as specified in submitted change requests. Ensures assigned due dates for submitted change requests are met. -Troubleshoots and performs research on basic claims adjudication issues or inquiries-Acquires a thorough understanding logic for claims adjudication, system constraints, conflicting benefit logic configurations, benefit coding table designs, plan - group - pharmacy carrier to benefit linking, to ensure proposed design satisfies the intended solution. -Ensures consistent customer satisfaction through consultation and collaboration with internal business partners to ensure that business requirements for submitted change requests are clearly understood, documented, developed, communicated, tested, and delivered flawlessly-Uses standardized methodology to ensure that appropriate rationale exists for non-standard design and that all efforts are undertaken to prevent inefficient and non-sustainable configuration structures-Reviews results of in-unit testing in order to validate new plan configurations-Assists in creating and maintaining documentation of clients' plan designs, detailing any custom maintenance processes and configuration best practices. Includes documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components. -Utilizes project planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources to achieve claims adjudication accuracyExpectations: -Interpret a variety of detailed and complex instructions furnished in written, verbal diagrams, or work and data flows.-Apply concepts such as fractions, percentages, ratios and proportions to practice situations -Read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations-Write reports, business correspondence, and procedure manuals-Present information and respond to questions from groups of managers, clients, customers, and the general public-Gather business requirements and client specifications.-Positively interact with clients, internal customers and peers. -Willingness to take accountability for achieving service commitments and a demonstrated ability to achieve results-Appear for work on time, follow directions from supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals, and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitmentSkills:customer service, associates degree, healthcare, PBM, pharmacy, benefits, health plan, medical claims, medical terminology, drug knowledgeTop Skills Details:excel, critical thinking, detail oriented, claims, insurance, benefit, analysis, reportingAdditional Skills & Qualifications:-Requires excellent customer service skills and interpersonal communication skills (listening/verbal/written) -Very strong Excel skills - v-lookups, pivot tables, and formulas - Passing score of 75% or better for the intermediate level Excel based administered testAssociate's degree (A.A.) from a College or university, or a minimum of three (3) years related experience and/or training; or equivalent combination of education and experience.Previous healthcare or PBM experience desired. Experience with pharmacy or medical claims analysis. nice to haveExperience Level:Entry Level About Aerotek:We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Keywords: Aerotek, San Diego , Benefit Configuration Specialist, Other , San Diego, California