Rx Benefits Analyst (hybrid)

PURPOSE OF THE JOB

• Responsible for internal and external functions that support accurate claim processing for medications.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• Level 1 - 3 years’ experience in pharmacy or medical field AND 1 year experience in prescription benefit administration
• Level 2 - 5 years’ experience in pharmacy or medical field AND 3 years’ experience in prescription benefit administration AND 1 year experience working in vendor applications (rebate, web tools, formulary tools)
• Level 3 - 5 years’ experience in pharmacy or medical field AND 5 years’ experience in prescription benefit administration AND 2 years’ experience working in vendor applications (rebate, web tools, formulary tools)
• Level 4 - 6 years’ experience in pharmacy or medical field AND 6 years’ experience in prescription benefit administration AND 5 years’ experience working in vendor applications (rebate, web tools, formulary tools) AND 5 years’ experience in progressive responsibility with allocation of resources and participating in management of complex projects

Required Education

• High-School Diploma or GED

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• Level 1 - 3 years’ experience in pharmacy benefit management or prescription claim administration AND 1 year experience with the current BCBSAZ PBM system AND 2 years’ demonstrated experience handling confidential information
• Level 2 - 3 years’ experience in pharmacy benefit management or prescription claim administration AND 1 year experience with the current BCBSAZ PBM system AND 1 year experience with BCBSAZ claims software/systems AND 3 years’ demonstrated experience handling confidential information
• Level 3 - 5 years’ experience in pharmacy benefit management or prescription claim administration AND 2 years’ experience with the current BCBSAZ PBM system AND 2 years’ experience with BCBSAZ claims software/systems AND 4 years’ demonstrated experience handling confidential information AND 5 years’ demonstrated experience handling vendor system coding and analytic functions
• Level 4 - 6 years’ experience in pharmacy benefit management or prescription claim administration AND 6 years’ experience with the current BCBSAZ PBM system AND 6 years’ experience with BCBSAZ claims software/systems AND 6 years’ demonstrated experience handling confidential information AND 5 years’ demonstrated experience handling vendor system coding and analytic functions AND 5 years demonstrated experience handling complex projects and allocation of resources

Preferred Education

• Associate’s degree in general field of study

Preferred Licenses

• N/A

Preferred Certifications

• N/A

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 medication related 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.

LEVEL 2 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION

• Communicates issues identified within vendor system effectively 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

LEVEL 3 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON; ACTS AS SUBJECT MATTER EXPERT

• Primary liaison for Pharmacy Management for applicable vendor applications.
• Primary SME contact for various internal departments within BCBSAZ.
• Builds reporting and analyzes data for benefit recommendations to management.

LEVEL 4 - LEAD - PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION

• 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 Support 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.
• The position 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.