Claims Pharmacy Benefit Manager Accumulator Specialist
About the position The Claims Pharmacy Benefit Manager (PBM) Accumulator Specialist serves as the subject matter expert for Pharmacy Benefit Manager (PBM) accumulators. Responsibilities include researching and resolving accumulator discrepancies, processing retroactive changes and cancellations, and maintaining claims processing knowledge. This position is eligible to work onsite, remote, or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Responsibilities • Review and analyze PBM Out of Balance reports weekly, identifying and resolve discrepancies. • Compare PBM and claims system data to determine corrective actions. • Run queries and collaborate with IT and PBM teams to resolve errors. • Communicate with internal teams and PBM via email, phone, and meetings. • Adjust overstated accumulator balances weekly. • Process group accumulator adjustments. • Participate in PBM conference calls and internal meetings. • Analyze and suggest process improvements. • Finalize and adjust claims, ensuring accuracy. • Work daily system-generated reports for claims control. • Maintain production, accuracy, and compliance standards. • Assist with accumulator-related testing. • Ensure confidentiality, compliance, and security policies are followed. Requirements • High school diploma or equivalent. • 3 years of claims processing experience with advanced accumulator knowledge. • PBM system experience preferred. • Strong verbal, written, and interpersonal skills. • Ability to interpret contractual language and benefit coding. • Excellent organizational, multitasking, and problem-solving skills. • Proficiency in claims systems, membership systems, imaging workflow, QMF, PBM systems, and Microsoft Office. • Strong math, reasoning, and communication skills. • Proven record of reliability and minimal unscheduled absences. Benefits • Incentive pay program (EPIP) • Health/Vision/Dental insurance • 6 weeks paid parental leave for new mothers and fathers • Fertility/Adoption assistance • 2 weeks paid caregiver leave • 5% 401(k) plan matching • Tuition reimbursement • Health & fitness benefits, discounts and resources Apply tot his job