Benefits Setup Analyst

DESIRED SKILLS AND EXPERIENCE

Responsible for the accurate and timely entry of plan benefit setups and maintenance revisions into the clients benefit setup system

Essential Job Functions:

- Responsible for reviewing, analysing, and implementing desired plan benefit features including formulary loads and performing quality assurance checks by testing claims against the desired benefit design.
- Ensures accurate claim processing by communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required
- Coordinates with internal and external customers to ensure the documentation, implementation, and modification of benefit plans is completed on a timely basis and is updated according to the clients policy and legal requirements.
- Responsible for researching, testing, and responding to inquiries regarding system capabilities and system problems related to plan benefit design from other internal departments such as Client Services and/or Quality Assurance
- Other assigned activities as determined by the Supervisor of Plan Design

Knowledge, Skills and Ability Requirements:

- Previous healthcare experience required
- Previous experience with online claim/benefit systems, claims adjudication, and data processing required.
- Previous pharmacy or prescription benefit experience required
- Strong data entry skills
- Strong communications skills both verbal and written
- Ability to adapt to a changing work environment including scheduling flexibility

Qualifications:

- Healthcare-related experience with understanding of plan benefit design required
- Experience with third party prescription/medical payment and/or claims adjudication systems required
- Direct experience working with clients required