Rx Benefits Analyst II
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
Purpose of the Job
Responsible for internal and external functions that support accurate claim processing for medications.
Essential Job Functions & 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 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
• 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
Within BCBSAZ and HCA, it is essential that we create a culture of inclusion and opportunity as well as actively guard against bias of any kind. Discrimination and racism are real. Our aim is to empower every member of our team to engage in our mission of improving health for Arizonans. We believe that the power and perspective of diversity and inclusion is in fact, essential to our success in serving clients, achieving our mission and creating a healthy environment for all.
BCBSAZ 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.
Skills / Requirements
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1. 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)
2. 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
3. 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
1. Preferred Job Skills
• Advanced PC proficiency with word processing, spreadsheets, and claims and imaging software (Levels 2 – 3)
2. Preferred Professional Competencies
• Effective interpersonal commuinication
• Multicultural sensitivity
• Claim system experience with pharmacy vendor software and/or systems (Levels 2 – 3)
3. Preferred Leadership Experience and Competencies