M&A Analyst/Associate focusing on renewable energy transactions, from analysis to closing. Collaborating on financial modeling and working closely with clients and senior consultants in a hybrid role.
About the role
- Configuration Analyst providing primary support for pharmacy plan configuration setups for clients. Analyzing and resolving issues in claims processing and operational gaps.
Responsibilities
- Primary support for on plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations
- Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation
- Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes
- Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action
- Resolution & Ownership of project-based work as assigned
- Provide first-tier triage support within SLAs/SLOs to verify and analyze pharmacy claims processing case research referred for validation
- Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required
- Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met
- Support the review, impact analysis, root cause assessment and preventive measures for issue management related workload
- Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy
- Stay current with external regulator guidelines such as Medicare, Medicaid, and state requirements, to make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations
- Provide consultation and peer review for configuration practices and design
- Identify functionality needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately
- Support the Sr. Analyst in documenting client plan standards
- Support in development of process documentation, including Policies and Procedures, to document Darwin Configuration operational processes
- Evaluate and analyze configuration processes and make recommendations for improvements
Requirements
- Associate or bachelor’s degree (In lieu of a degree, equivalent relevant work experience may be considered)
- 3+ years of work-related experience benefit plan configuration and/or implementations
- 2+ years of experience related to Pharmacy Benefit Manager Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare
- Experience working with SQL and Excel tools
- Ability to establish good interpersonal skills
- Excellent oral and written communication skills
- This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members
- This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).
Benefits
- Flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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