Additional Job details: Candidate must act as a consultant to leadership and other internal/external clients as it relates to all components of Prescription claim Point-Of-Sale triaging responsibilities. Ideal candidates would possess: PBM knowledge, including Medicare, Health Plans, PPOs, Networks Prescription claims processing knowledge, including Copays, Deductibles Ability to work in a fast-paced environment while ensuring 100% accuracy
Location: STL or Virtual/Work from Home
Does this Position allow for virtual / remote work?: Yes What other locations would you consider for this position to be located? Franklin Lakes, NJ
Assignment Duration: 8 months +
This position is Right to hire for the right fit for 1 exemplary candidate out of 4 if business permits
Will you consider non-local candidates willing to relocate at their own expense?: Yes
Interview Process: Phone interviews only (video conferencing if appropriate)
If you are conducting face-to-face interviews, are you willing to interview non-local candidates via teleconference in lieu of face-to-face?: Yes
List 3-5 Required Skills: PC skills including intermediate to advanced knowledge of Microsoft Office Suite; SQL preferred; Mainframe experience preferred Strong verbal and written communication skills Problem solver. Ability to work independently and within a team
The POS Triage Business Analyst serves as a front-line resource for research and analysis for internal and external customer inquiries regarding the claims adjudication system for the Service Reliability organization within PBM processing. This position is the primary analyst responsible for the research and analytics of Point-of-Sale claims processing system issues and questions.
Candidate must act as a consultant to leadership and other internal/external clients as it relates to all components of the POS Triage responsibilities.
Knowledge of PBM industry/Managed care industry is critical; Medicare knowledge preferred; Previous experience in benefits or customer service; Strong written and oral communication skills; Detail oriented with strong analytical and problem solving skills; Ability to adapt in a dynamic work environment and make independent decisions; Ability to manage timelines and meet tight client deadlines; Strong focus on customer service; Demonstrated ability to work with other departments/teams to resolve issues; Willingness to work a flexible schedule for peak volume times
Support analytical and problem solving activities related to claims processing system issues or questions to ensure that all problem tickets are accurately resolved or correctly reassigned. Master the business concepts related to all aspects of claims processing. Provide SME claims processing knowledge to any and all other teams or departments needing assistance.
Serve as technical expert for operational departments regarding the claims processing system.