Pharmacy Benefit Analyst

Premera Blue Cross

5d•Remote

About The Position

As a Pharmacy Benefit Analyst, you’ll serve as the technical subject matter expert supporting the Pharmacy and Product Configuration teams on Pharmacy Benefit Manager (PBM) benefit coding and programs. You will research and analyze benefit configuration needs, troubleshoot process and system issues, and partner with internal teams and external vendors to ensure accurate PBM set-up. In this role, you’ll validate claim adjudication and plan configuration through quality assurance and testing, provide oversight of PBM data interfaces, and assess configuration changes for compliance with applicable state and federal regulations. You’ll also respond to inquiries, recommend standard and custom configuration options, and identify and escalate potential risks impacting benefit configuration. This is a high‑impact individual contributor role where you’ll work in a small, highly visible team, with your work directly affecting how pharmacy benefits function for members and providers.

Requirements

Bachelor’s degree or four years equivalent experience (Required).
3 years PBM technical experience in benefit coding or claims adjudication or related area which includes at least one year experience in PBM benefit configuration or equivalent (Required).

Nice To Haves

Washington Pharmacy technician License (Preferred).
In-depth knowledge of pharmacy benefit coding (Preferred).
Previous experience in Premera product configuration (Preferred).
Previous experience troubleshooting production issues within claims or customer information systems or databases (Preferred).
Medicare Part D Benefit Experience (Preferred).
Demonstrated ability to independently analyze pharmacy product designs and develop an alternative configuration approach to achieve desired outcome (Preferred).
Experience in proactively applying analytical, problem solving and / or technical abilities to daily responsibilities.
Ability to learn and effectively understand/utilize new concepts and functions quickly.
Strong written and verbal communication skills, and ability to establish and maintain effective relationships.

Responsibilities

Provide technical support and partners with PBM vendor (Express Scripts), Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding, interpretation of pharmacy benefits and new pharmacy product builds.
Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been completed appropriately and reviews system generated outputs to validate outcomes.
Provide oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct.
Research and provide direction to team on complex PBM benefit coding and compliance issues.
Provide input to PBM vendor, IT and teams on custom benefit requests and make recommendations for alternative approaches.
Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing.
Collaborate with cross functional Premera teams (sales, system configuration, claims, contract services, group set-up, membership and billing, customer service), on feasibility and processing requirements for new and custom products and services, to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues.
Create, maintain and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work and mitigate any risks.
Develop processes and procedures for new and changing requirements.
Develop training content and provide instruction to staff both 1:1 and in classroom setting. Work collaboratively with training staff in developing training programs.
Monitor delivery and tracking for wide range of inquiries, activities and workload within team providing direction to team members and on-going status reports to leadership.
Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.