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Pharma Benefit Analyst

Keywords / Skills : Good Excel, Typing, Good Communication

0 - 1 years
Posted: 2018-08-31

Customer Service/ Call Centre/ BPO
Customer Service Executive (Non-voice)
Posted On
31st Aug 2018
Job Description

Analyze benefit requests and secure all necessary data to ensure appropriate. Implementation based on applied logic of RxCLAIM (by SXC) pharmacy claim adjudication system.

Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.

Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system.

Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system.

Ensure timely communication of any issues and/or information needed to complete a plan request.

Develop client specific implementation plans and manage implementation processes in accordance with department protocol.

Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests.

Develop and run macros in RxCLAIM to implement plan requests.

Perform claim testing to ensure accurate claim adjudication.

Maintain acceptable and appropriate quality levels and production turnaround times

Adhere to all documentation standards within the department.

Participate in team meetings.

Ability to work in a constantly changing environment.

Performance Standard:

To maintain an accuracy rate - Monthly (DPU: 98.10%; DPMO: 99.90%; IQR: 92.50%)

Completes assigned projects on time, per TAT defined


Microsoft Office proficiency Word and Excel, specifically Advanced Excel skills -- must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting;

Excellent analytical skills.

Good written and verbal skills.

Detail oriented.


Bachelor's Degree in Pharmacy

Certified pharmacy technician preferred

Should be Flexible to work in Night Shifts.

About Company

Payroll Company Magna Infotech
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