Analyst, Claims

1. About Our Client:

The organization operates in the pharmacy benefit management industry, addressing challenges related to the accurate administration of pharmacy benefits for customers, clients, members, and pharmacies. It focuses on leveraging technology and process improvements to resolve claim processing issues and adapt to continuous changes in the pharmacy benefit space.

2. About the Opportunity:

The Analyst, Claims plays a vital role in analyzing, documenting, and reporting claim processing issues to ensure alignment with operations and improve benefit administration accuracy. This role contributes by identifying root causes of issues and recommending corrective actions that reduce financial risk and enhance system performance.

3. Responsibilities:

• • Collaborate with benefit configuration analysts and internal customers to research and determine root causes of claim processing issues
• • Manage multiple claim processing issues to enhance claim processing accuracy
• • Maintain intermediate to advanced knowledge of benefit designs and adjudication system functions
• • Apply advanced reporting and data analysis to identify error types and quantify affected claims
• • Document and share comprehensive findings and systemic impact analyses with leadership and relevant teams
• • Recommend retraining or corrective actions to mitigate future occurrences and financial risks
• • Adapt to industry changes and evolving technology, understanding legacy and emerging products
• • Use workflow management and issue resolution tools to respond to moderate to complex customer requests
• • Assess business needs and participate in process improvement, cost reduction, and automation efforts
• • Perform other duties as assigned

4. Requirements:

• • Associate''s degree or equivalent work experience
• • Basic knowledge of operational applications, with minimal guidance required
• • Preferred experience with claims processing, Microsoft Office (Word, Excel, PowerPoint), formulary management, request management tools, and reporting software (3D QlikView/QlikSense)
• • Commitment to compliance program objectives
• • Ability to interact cooperatively and respectfully with colleagues

5. Pay Range and Compensation Package:

• USD 51,409.00 - USD 61,201.00 per year

6. Benefits & Perks:

• • Health, dental, and vision insurance
• • 20 days paid time off
• • Four weeks paid parental leave
• • Nine paid holidays
• • 401(k) company match up to 5% with no vesting requirement
• • Adoption assistance program
• • Flexible spending account
• • Educational assistance and professional membership support
• • Referral bonus program up to $750

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.