Benefit Design and System Support Analyst

Job Overview

The Benefit Design and System Support Analyst provides comprehensive knowledge of the claim processing system to employees and customers, including answering questions and assisting with problem resolution. This remote role involves managing tickets, troubleshooting issues, and ensuring accurate benefit designs and claims processing in the pharmacy benefit management industry.

Responsibilities

• Manage tickets within a ticketing system and resolve claims processing issues in a timely manner.
• Adjudicate information on multiple software platforms and enforce established procedures.
• Identify and correct benefit design errors, perform financial audits, and determine impacts.
• Provide and present audit findings to account management and leadership.
• Facilitate benefit designs for new clients based on documentation.
• Communicate with implementation, EDI, clinical, and account management teams to address questions and updates.
• Input and update clinical information in the claims processor after testing.
• Assist customer service representatives with troubleshooting.
• Collaborate with external programming teams to resolve errors.
• Participate in developing quality assurance for internal processes and evaluate quality standards.
• Abide by HIPAA obligations related to protected health information and report violations.
• Attend and complete required HIPAA training.

Qualifications

• Demonstrated competency in HIPAA training.
• Ability to handle comprehensive knowledge of claim processing systems.
• Skills in troubleshooting, auditing, and communicating across teams.
• Flexibility to adapt to changing duties and responsibilities.