Benefit Plan Configuration Advisor Principal - Remote in California Preferred
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Benefit Plan Configuration Advisor Principal - Remote in California PreferredJob Description
Responsible for providing subject matter expertise in interpreting complex benefit configuration plan designs for new business installations and maintenance of existing business. Serves as a liaison in defining best configuration/testing practices among multiple lines of business. Oversight of training and documentation of best practices across multiple lines of business. Assumes additional responsibilities in the absence of Manager.
Responsibilities
• Develops, recommends and implements plan(s) of action to implement recommended changes to increase efficiency and performance.
• Provides a structure to optimize the experience, skill, knowledge and capability of the team.
• Facilitates projects that support process improvements, leveraging new system capabilities and the integration of data/ other applications into existing systems.
• Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution.
• Responsible for managing complex clients / programs from a coding, testing, validation perspective as needed.
• Leads, coordinates and consults on intermediate level projects including new customer implementations, global projects spanning multiple clients or systems, and system implementations or enhancements.
• Provides consultation to internal/external partners to ensure intent is accurately captured and implemented for client benefit requests.
• Collaborates internally to determine best operational approach for new business installations and benefit adjustments.
• Oversees development of departmental policies and procedures and trains peers on the benefits teams.
• Demonstrates an in-depth working knowledge of the benefits department`s workflow and the impact to other departments.
• Manages project plans and performs analysis to ensure the initiative deadlines are met.
• Oversees configuration and testing of system enhancements.
• Other duties as assigned.
Education & Experience
• Bachelor's degree or equivalent combination of education and/or work experience; HS diploma or GED is required
• 7 years of experience in Benefit Plan Configuration/Analysis
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
• 7+ years of experience in benefit plan configuration/analysis.
• Strategic mindset for optimal operational effectiveness.
• Comprehensive understanding of adjudication processes and associated applications.
• Extended experience of adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
• Ability to understand the system's functionality and business policies.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to prioritize all work deliverables effectively and independently.
• Excellent time management, organizational and written/verbal communication skills.
Preferred Qualifications
• Experience with adjudication processes (FirstRx preferred, analyzing benefit plan design and system application
• Previous PBM or Pharmacy experience
• Experience supporting Medi-Cal
• Experience using FirstRx
Physical Demands
• Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
• Must be able to constantly operate a computer and/or other office productivity equipment
• Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Apply Now
Apply Now
Job Posting Title
Benefit Plan Configuration Advisor Principal - Remote in California PreferredJob Description
Responsible for providing subject matter expertise in interpreting complex benefit configuration plan designs for new business installations and maintenance of existing business. Serves as a liaison in defining best configuration/testing practices among multiple lines of business. Oversight of training and documentation of best practices across multiple lines of business. Assumes additional responsibilities in the absence of Manager.
Responsibilities
• Develops, recommends and implements plan(s) of action to implement recommended changes to increase efficiency and performance.
• Provides a structure to optimize the experience, skill, knowledge and capability of the team.
• Facilitates projects that support process improvements, leveraging new system capabilities and the integration of data/ other applications into existing systems.
• Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution.
• Responsible for managing complex clients / programs from a coding, testing, validation perspective as needed.
• Leads, coordinates and consults on intermediate level projects including new customer implementations, global projects spanning multiple clients or systems, and system implementations or enhancements.
• Provides consultation to internal/external partners to ensure intent is accurately captured and implemented for client benefit requests.
• Collaborates internally to determine best operational approach for new business installations and benefit adjustments.
• Oversees development of departmental policies and procedures and trains peers on the benefits teams.
• Demonstrates an in-depth working knowledge of the benefits department`s workflow and the impact to other departments.
• Manages project plans and performs analysis to ensure the initiative deadlines are met.
• Oversees configuration and testing of system enhancements.
• Other duties as assigned.
Education & Experience
• Bachelor's degree or equivalent combination of education and/or work experience; HS diploma or GED is required
• 7 years of experience in Benefit Plan Configuration/Analysis
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
• 7+ years of experience in benefit plan configuration/analysis.
• Strategic mindset for optimal operational effectiveness.
• Comprehensive understanding of adjudication processes and associated applications.
• Extended experience of adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
• Ability to understand the system's functionality and business policies.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to prioritize all work deliverables effectively and independently.
• Excellent time management, organizational and written/verbal communication skills.
Preferred Qualifications
• Experience with adjudication processes (FirstRx preferred, analyzing benefit plan design and system application
• Previous PBM or Pharmacy experience
• Experience supporting Medi-Cal
• Experience using FirstRx
Physical Demands
• Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
• Must be able to constantly operate a computer and/or other office productivity equipment
• Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Apply Now
Apply Now