Key Responsibilities

• Analyze large datasets to identify trends, patterns, and anomalies related to pharmacy benefit management.
• Generate and present regular reports on key performance indicators (KPIs), claims processing metrics, and operational efficiencies.
• Develop dashboards and visualizations to aid in decision-making and strategic planning.
• Evaluate and refine existing operational processes to enhance efficiency and accuracy.
• Identify opportunities for automation and streamline workflow to reduce manual effort and errors.
• Monitor and audit pharmacy claims and transactions to ensure compliance with plan guidelines and regulatory requirements.
• Investigate and resolve discrepancies, disputes, and escalations related to claims processing.
• Provide analytical support for client presentations and benefit plan evaluations.
• Support or lead projects related to new initiatives, system upgrades, or process improvements.

Required Skills

• Advanced knowledge of PBM operations.
• RxCLAIM claim adjudication.
• Eligibility and benefits.
• Experience with quality and/or testing programs.
• intermediate Microsoft Office.
• Project management skills.

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