Prescription Plan Design Escalations Analyst I-II (Hybrid)
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
Responsible for internal and external functions that support accurate claim processing for medications.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
Experience in pharmacy or medical field
Level 1 – 3 years
Levels 2 and 3 – 5 years
Level 4 – 6 years
Experience in prescription benefit administration
Level 1 – 1 year
Level 2 - 3 years
Level 3 – 5 years
Level 4 – 6 years
Experience working in vendor applications (rebate, web tools, formulary tools)
Level 2 – 1 year
Level 3 – 2 years
Level 4 – 5 years
5 years’ experience in progressive responsibility with allocation of resources and participating in management of complex projects (Level 4)
Required Education
High-School Diploma or GED
Required Licenses
N/A
Required Certifications
N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
Experience with a pharmacy benefit management or prescription claim administration
Levels 1 and 2 – 3 years
Level 3 – 5 years
Level 4 – 6 years
Experience with the current BCBSAZ PBM system
Levels 1 and 2 – 1 year
Level 3 – 2 years
Level 4 – 6 years
Experience with BCBSAZ claims software / systems
Level 2 – 1 year
Level 3 – 2 years
Level 4 – 6 years
Demonstrated experience handling confidential information
Level 1 – 2 years
Level 2 – 3 years
Level 3 – 4 years
Level 4 – 6 years
Demonstrated experience handling vendor system coding and analytic functions
Level 3 – 5 years
Level 4 – 6 years
5 years’ demonstrated experience handling complex projects and allocation of resources (Level 4)
Preferred Education
Associate’s degree in general field of study
Preferred Licenses
N/A
Preferred Certifications
N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
LEVEL 1 – PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW
Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
Support internal and external customers with information on benefits applicable to medication claims
Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
Communicate recommendations in regard to medication claim processing and benefit decisions.
Monitor and investigate reported plan set up system issues
Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
Resolve escalated member issues
Research & provide recommendations for accumulations issues
Logs all benefit setup issues on error tracking reports
Provide monthly updates on error resolutions and impact reports
LEVEL 2 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
Communicates issues identified within vendor system effectively to team.
Communicates issues identified within plan setup testing or another escalated research to team
Strategizes solutions for issue resolution and communicates plans to team.
Provides written documentation for desk levels.
Provides support to other team members when necessary
Review plan testing documents for minimal accuracy
LEVEL 3 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON, ACTS AS SUBJECT MATTER EXPERT
Primary liaison for Pharmacy Management for applicable benefit design questions
Primary SME contact for various internal departments within BCBSAZ In regard to pharmacy plan setup and design
Builds reporting and analyzes data for benefit recommendations to management.
Review and determine pharmacy benefit setup upon renewal for all benefit plans
Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays
Submit drug code assignments to enrollment for all benefit plans Maintain pharmacy drug code matrix
LEVEL 4 – LEAD – PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION
Perform quality checks and analysis on drug code setup from other analysts
Review escalated plan testing questions for accuracy and make corrections as needed
Setup all complex pharmacy benefit plan designs
Setup all complex patient pays, and any other design element related to complex pharmacy benefits
Works with Pharmacy Management Leadership team to identify project prioritization
Allocates resources to ensure required work is accomplished within defined time frames
Assigns Tasks to Analysts and Specialists as needed
ALL LEVELS
Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
Properly track all pharmacy benefit issues & concerns
The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned.
competencies
REQUIRED COMPETENCIES
Required Job Skills
Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3)
Required Professional Competencies
Take initiative
Establish and maintain working relationships in a collaborative team environment
Flexibility in prioritization of workflow
Compose a variety of business correspondence
Required Leadership Experience and Competencies
Make use of employees' skills and abilities to deliver business objectives
Use available information to focus the team's activities and identify priorities
PREFERRED COMPETENCIES
Preferred Job Skills
Advanced PC proficiency with word processing, spreadsheets, and claims and imaging software (Levels 2 – 3)
Preferred Professional Competencies
Effective interpersonal communication
Multicultural sensitivity
Claim system experience with pharmacy vendor software and/or systems (Levels 2 – 3)
Preferred Leadership Experience and Competencies
N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.