TEKsystems-posted 10 months ago
$21 - $21/Yr
Entry Level
Tempe, AZ

The position involves applying pharmacy, formulary, and benefit configuration to effectuate change as specified in submitted change requests. The individual will ensure that assigned due dates for these requests are met and will troubleshoot and perform research on basic claims adjudication issues or inquiries. A thorough understanding of the Medimpact system logic for claims adjudication is required, including system constraints, conflicting benefit logic configurations, and benefit coding table designs. The role also involves ensuring 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. The individual will use 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. Additionally, the role includes reviewing results of in-unit testing to validate new plan configurations and assisting in creating and maintaining documentation of clients' plan designs, detailing any custom maintenance processes and configuration best practices. This includes documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components. The individual will utilize project planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources to achieve claims adjudication accuracy.

  • Apply pharmacy, formulary, and benefit configuration to effectuate change as specified in submitted change requests.
  • Ensure assigned due dates for submitted change requests are met.
  • Troubleshoot and perform research on basic claims adjudication issues or inquiries.
  • Acquire a thorough understanding of Medimpact system logic for claims adjudication.
  • Ensure consistent customer satisfaction through consultation and collaboration with internal business partners.
  • Use standardized methodology to ensure appropriate rationale exists for non-standard design.
  • Review results of in-unit testing to validate new plan configurations.
  • Assist in creating and maintaining documentation of clients' plan designs.
  • Utilize project planning, prioritizing, and organizational skills to ensure timely deliverables.
  • 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.
  • Medical, dental & vision
  • Critical Illness, Accident, and Hospital
  • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
  • Life Insurance (Voluntary Life & AD&D for the employee and dependents)
  • Short and long-term disability
  • Health Spending Account (HSA)
  • Transportation benefits
  • Employee Assistance Program
  • Time Off/Leave (PTO, Vacation or Sick Leave)
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