PBM Integration Analyst

Overview

Scope of Responsibilities : The PBM Integration Analyst is a member of the ProAct IT team reporting to the Manager of Partner Integration.

This role will be responsible for supporting the configuration, testing and maintenance of partner integrations and claim record analysis and remediation.

Job Summary : The Integration Analyst acts as ProAct’s SME on all aspects of accumulators, involving claim system behavior, data exchanges with TPAs and service partners, development of IT processes and procedures, and QA of accumulator data.

This position will assist in the implementation of new clients, support of existing clients through troubleshooting accumulator data and file feeds and identifying and solving for complex data problems as they occur.

Responsibilities

Job Duties :

• Support the execution of all accumulator operations and interfaces from implementation through ongoing operations and maintenance.
• Responsible for working with new and existing partners in the development and administration of ProAct’s core business processes related to accumulators, which includes working with a variety of TPA’s (Third Party Administrators), electronic transmissions of various file types, and reporting needs
• Work with cross functional teams to systematically integrate and support new partners into standard accumulator business processes
• Partner with development to test custom programming related to processing and automating accumulator data
• Analyze business data to perform root cause analysis on data issues as they occur
• Explain requirements and processes to internal / external technical and business partners in a variety of ways (use cases, logical diagrams, flow charts)
• Responsible for completing all mandatory and regulatory training programs
• Perform other duties as assigned

Qualifications

Education : Bachelors degree preferred. Relevant experience considered for exceptional candidates.

Experience :

• Pharmacy Technician or related experience highly desirable
• 1-3 years of PBM experience in claims or insurance operations

Special Conditions of Employment :

• Drug test
• Initial and continuous exclusion and sanction / disciplinary monitoring
• Any and all additional eligibility requirements based on the specific position
• Must sign and agree to the Elevated Privileges Acceptable User Agreement

Job Skills Required :

• Ability to understand behavior of claims systems, file feeds, and other elements related to processing accumulator data
• Ability to identify data quality issues and define / implement corrective solutions
• Identify opportunities and recommend changes to IT that will help ensure optimal performance in our database and systems environment
• Coordinate activities, changes, and communication with internal groups and business partners
• Ability to handle multiple tasks and changing priorities in a fast-paced, rapidly growing environment
• Excellent verbal and written communication skills
• Self-motivated with excellent customer service and problem-solving ability
• Vigilance in adherence to system and industry security protocols

Compensation : $26.00-33.50 / hr

$26.00-33.50 / hr

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.

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