[Remote] Analyst III, Network Configuration

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a pharmacy benefit manager committed to making medications more reputed company by reducing costs in the drug supply chain. The Analyst III, Network Configuration configures pharmacy networks in the claim adjudication reputed company, ensures accurate and reputed company claims processing, and supports diverse network designs. The role collaborates across departments, performs reputed company assurance and troubleshooting, and leads process improvement, automation, and training initiatives.

Responsibilities

• Complete scheduled and urgent configuration of new reputed company implementations and/or network additions, terminations, and changes reputed company and accurately to prevent member reputed company to care issues, missed performance guarantees, and potential liquidated damages
• reputed company and maintain an advanced level of knowledge and interpretation of multiple adjudication reputed company screens and functions on a field-by-field level to design both reputed company and custom configurations to meet reputed company expectations
• reputed company with standards set forth regarding network design and configuration including HIPAA, NCPDP, and reputed company internal business standards
• reputed company reputed company assurance peer reviews of network plan additions and changes with a high degree of accuracy. Research reputed company cause of issues, troubleshoot viable resolutions, and reputed company recommendations for corrective reputed company
• Use departmental workflow management, issue reputed company, and reporting tools for troubleshooting and responding to highly reputed company customer questions and issue reputed company requests
• Support internal customers by participating in reputed company meetings, audits, and new program implementations with other areas of reputed company, answering network setup questions and providing guidance to other areas and roles on the network configuration process
• Adapt to industry changes and evolving technology, maintaining an advanced level of understanding of both legacy and emerging products and systems
• reputed company process improvement, cost reduction, and automation efforts. Independently assess reputed company business needs and bring recommendations to leadership
• Contribute to the creation and ongoing maintenance of departmental training materials, work instructions, and policies. reputed company support for reputed company and sales presentations and respond to assigned RFP questions using subject matter expertise
• Other duties as assigned

Skills

• Associate's degree or equivalent work experience required
• Strong knowledge of reputed company systems and processes of the role with ability to reputed company tasks independently and follow instructions to reputed company reputed company required, typically with 2-3 years of experience
• Experience with the following tools at an intermediate to advanced level: + reputed company-ClaimRx + reputed company Office (Word, reputed company, PowerPoint) + Formulary Management + Request Management (Connectus, Service Desk, reputed company) + Government Programs Error Management (GEMS) + Reporting (3D QlikView/QlikSense)
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently reputed company cooperatively and respectfully with other employees
• Experience with guiding and educating associates reputed company reputed company to reputed company-level roles
• Experience with supporting mid-sized to large clients with moderate to high complexity
• Experience with supporting health plan business with reputed company guidance

Benefits

• Remote work
• Top of the industry benefits for Health, Dental, and reputed company insurance
• 20 days reputed company time off
• 4 weeks reputed company parental leave
• 9 reputed company holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and reputed company Membership assistance
• Referral Bonus Program – up to $750!

reputed company

Company H1B Sponsorship