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Benefits Analyst III

  • Job Family: Business Support
  • Type: Full time
  • Date Posted:
  • Req #: JR58524

Location:

  • VA, RICHMOND
  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
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Description

Position: Benefits Analyst III

Location: Atlanta, GA, St Louis, MO, Richmond, VA, Indianapolis, IN, Columbus, OH

Schedule: Flex 1 (0-3 days per month in the office)

Responsible for identifying complex business needs and translates the needs into application software requirements in support of operations, productions and projects.

Primary duties may include, but are not limited to:

  • Designs and builds new complex non-standard benefit plans,
  • reviews and analyze benefit summaries; and identifies best approach to code/develop benefits to achieve optimum adjudication levels.
  • Maintains avoidance to negative financial, regulatory, and operational impact.
  • Performs testing and quality assurance of new product developed.
  • Research and analysis of RFP proposals, and product projects.
  • Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality. 
  • Researches and responds to complex inquiries from various departments.
  • May consult with and mentoring of less experienced team members.
  • Serves as trainer for standard and highly customized benefit configuration.
  • Represents department in production related meetings including product development, design and implementation.
  • Must be able to perform all duties of lower level positions as directed by management.
  • Provide support for the development and administration of specialized pharmacy benefit functions including: pharmacy benefit builds, system functionality and capability consultation, adjudication logic, pre and post production auditing.
  • Leads the preparation and submission of detailed updates of benefit changes to Pharmacy Benefit Manager (PBM),
  • Oversees the design and execution of user acceptance testing (UAT) of changes and ensures such changes are implemented on time, and coordinates post implementation verification that claims are processed as intended.
  • Support cross-functional teams to ensure accuracy of pharmacy claims activity, and sustain pharmacy benefit integrity.
  • Create and maintain databases to track pharmacy benefits performance and trending; and provide oversight for pharmacy claim issue management and resolution, to include documentation, resolution and trending of claims issues
  • Analyze data and summarize performance using summary statistical procedures.
  • Develop and analyze pharmacy benefits performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
  • Create and publish periodic reports, as well as any necessary ad hoc reports.
  • May require taking pharmacy benefits issue/escalation(s) and devising best way to develop appropriate diagnostic and/or tracking data that will translate pharmacy benefit configuration and design into integrity-driven resolution.
  • Performs detailed analysis to define root cause for reported issues and facilitate issue resolution.
  • Analyzing, reporting and developing recommendations on data related to multiple, varied business metrics.

Requires a BA/BS in a related field and minimum of 3 years' experience in claims processing, previous medical health care, analytical experience, or project management experience, or 5 years of benefit coding experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications

  • Healthcare experience required
  • SAS Enterprise Guide, Microsoft Office Suite (Excel, Word, Access, PowerPoint, Outlook, etc.) required.
  • Basic SQL and Visual Basic understanding preferred.
  • SQL Management Studio, Power BI, Tableau, Teradata SQL preferred.
  • Pharmacy claims experience preferred.
  • Experience in pharmacy operations, with knowledge of drugs, drug classes, formulary implementation
  • Managed Care experience preferred.
  • Experience with relational databases and knowledge of query tools and statistical software is required.
  • Ability to manipulate large sets of data.
  • Strong analytical, organizational, presentation, and problem solving skills.
  • Must have excellent written and verbal communication skills, advanced critical thinking and problem solving skills.
  • Proficient to Advanced skills in: Excel/Access applications to include data manipulation and reporting analysis with
  • complex formulas.
  • Pharmacy Technician Certification Board (PTCB – a national pharmacy technician association), a plus but not required.
  • Pharmacy Benefit Manager (PBM) experience highly preferred.
  • This position supports a sensitive, high-touch book of business with strategic demands and precise execution required;
  • and is a functionally demanding role with both technical and operational deliverables.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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