Benefit Design and System Support Analyst REMOTE

Benefit Design and System Support Analyst

We wanted a PBM that worked better… so we created one.

Liviniti , the leading disruptor in the PBM industry, simplifies the complexities of navigating through the Pharmacy Benefit Manager world by offering a value-added approach to ensure the employer absolute freedom, control, and choice to their health plan structure without compromising patient experiences and outcomes. We improve healthcare and reduce rising prescription costs for employers and their employees. We are looking for individuals who are passionate, strong, and committed to developing systems and service solutions that promote our business goals and commitments.

Liviniti is searching for incredible talent! We continue to experience accelerated growth in a rapidly changing industry. There's never been a better time to join our team.

We are currently seeking a Benefit Design and System Support Analyst. This is a remote position .

Role and Responsibilities

The Benefit Design and System Support Analyst provides Liviniti employees and customers with comprehensive knowledge of the claim processing system. This includes answering questions and assisting with problem resolution.

• Manages tickets within a ticketing system; troubleshoots and resolves tickets that are placed in the claims processing queues in a timely manner.
• Adjudicates information on multiple software platforms.
• Enforces procedures that are put in place by the Benefit Design Supervisor, Director of Claims Processing, and other Leadership.
• Identifies and corrects Benefit Design errors within the claims processor based on client documentation. This may include performing financial audits on the error(s) found and determining impact for the client and / or Southern Scripts.
• Provides and potentially presents audit findings to Account Management and, on occasion, the Leadership team.
• Facilitates benefit designs for new clients within the claims processor based off of documentation.
• Communicates with the Implementation team to discuss and / or ask questions regarding benefit designs for new clients.
• Communicates with the EDI team to discuss and / or ask questions regarding various data files.
• Communicates with the Clinical team to discuss and / or ask questions regarding clinical edits that are active for current clients.
• Works in conjunction with the Clinical team to input information into the claims processor and makes updates based on extensive testing to ensure the clinical request is to appropriate specifications.
• Communicates with the Account Management team to facilitate benefit design updates and obtain appropriate documentation for current clients.
• Assists Customer Service Representatives with troubleshooting and resolving issues within our claims processor, when appropriate.
• Works in conjunction with an external programming team to analyze and resolve programming error(s) within our claims processor.
• Participates in developing additional quality assurance for internal processes.
• Plays an active role in evaluating quality standards from an objective point of view and ensuring the proper checks and balances are applied to all parts of the Claims Processing procedures.
• Abides by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, whether individually or by another, reports the violation to the Compliance Officer and / or Human Resources.
• Attends, completes, and demonstrates competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that the job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

What We Have to Offer

Our benefits package is designed to keep our employees happy and healthy - physically, mentally and financially.

Required Skills and Competencies

Supervisory Responsibility

This position has no supervisory responsibilities.

Position Type and Expected Hours of Work

This is a full-time salaried position. Days and hours of work are Monday through Friday; 40+ hours a week, with occasional after-hours or weekend duties. Position can be remote or onsite.

Travel

No travel expected for this position.

Qualifications and Education Requirements

Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge. EOE M / F / V / D

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