Pharmacy Benefit Auditor – CarelonRx

Pharmacy Benefit Auditor – CarelonRx

Location : The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office). (National 50 necessity)

A proud member of the Elevance Health family of companies , CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

The Business Analyst III is responsible for analyzing pharmacy benefit coding systems against business criteria.

The primary focus is to work on a quality review with a diverse scope in which the analysis of data requires evaluation in comparison to system findings and per department policies and procedures. Provides written and/or verbal feedback to peers and/or internal stakeholders. Collaboratively identifies areas of pharmacy plan-build improvement with other departments to ensure plan-build accuracy. Responsible for driving service quality excellence by evaluating the accuracy of a pharmacy plan build. Serves as a subject matter expert on pharmacy benefits and pharmacy coding system setup.

How you will make an impact:

May provide direction and guidance to team members and serve as an expert for the team.

Ability to thrive with multiple, complex, and timeline-driven work efforts.

Ability to function as a team lead and be comfortable giving direct instruction to peers and stakeholders.

Effective relationship-building with internal partners.

Identify, assess, and mitigate risk.

Consult with business partners concerning the application and implementation of pharmacy benefit programs.

Perform pharmacy benefit quality reviews for multiple lines of business, functions, and systems.

Recognize, analyze, and design solutions to address complex and varied business needs.

Analyze and interpret data and make recommendations for change based on pharmacy operations procedures, system requirements, judgment, and experience.

Minimum Requirements:

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications, Skills, and Experiences:

CPhT is preferred.

Pharmacy plan benefit coding and/or pharmacy plan quality review experience strongly desired.

Pharmacy operations experience preferred.

An in-depth understanding of pharmacy benefit design preferred.

Demonstrated success in training and in a team lead position strongly desired.

Ability to consistently exceed expectations for quality, timeliness, and data accuracy metrics desired.

Knowledge of systems capabilities, and business operations; including internal systems, Excel, Word, Visio, Outlook, PowerPoint, MS Teams, SharePoint, JIRA, and Salesforce is strongly preferred.

Facilitation, with impressive oral and written communication highly desired.

Experience with reporting and analytics desired.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.