Claims Technical Analyst, Sr.

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Claims Technical Analyst, Sr.

Job Description

The Senior Claims Technical Analyst is responsible for serving as the claims analysis resource for assigned operations teams. This role is responsible for performing complex and escalated client, member and pharmacy remediation analysis. This role is also responsible for providing training and mentorship to Claims Technical Analysts and Associate Analysts, along with leading process improvement and technology uplift efforts for department level applications.

Responsibilities

Serve as lead Analyst for complex and/or escalated analysis requests; coordinate requests from internal and external clients and establish timelines, as well as presenting results

Train Claims Technical Analysts and Associate Analysts on specific job functions; maintain training material and present materials in shadowing and classroom settings

Review, perform root cause analysis, and monitor system defects on escalated issues; diagnose claim issues, assess claim trends, develop solutions and initiate appropriate claim resolution strategies

Partner with cross functional teams to maintain, troubleshoot and improve analysis tools (Query tool requirements and Claims Reprocessing Tool Mechanism) and processes

Develop and perform documented test case scenarios to support existing and newly developed tools and applications

Other duties as assigned

Minimum Qualifications

Bachelor’s degree in Business, Computer Science, IT, Mathematics, Finance or related area of study; or equivalent combination of education and/or relevant work experience; HS diploma or GED required

5 years of work experience in data analysis, including 2 years of experience working with claims data or systems

Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Strong negotiation and persuasion skills

Strong verbal and written communication skills

Ability to coordinate multiple projects/tasks simultaneously under strict timelines

Strong analytical, problem solving, and decision-making skills

Ability to work in fast-paced, collaborative team environment

Advanced level Microsoft Excel Analysis Skills

Ability to present complex material to a variety of audiences in plain language

Experience utilizing advanced query tools and Structured Query Language (SQL)

Experience with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations

Preferred Qualifications

Training experience

2 years of experience working with RxClaim system

Minimum Physical Job Requirements

Ability to work outside of Prime’s core business hours of 9:00 a.m. – 4:00 p.m. as needed

Constantly required to sit, use hands to handle or feel, talk and hear

Frequently required to reach with hands and arms

Occasionally required to stand, walk and stoop, kneel, and crouch

Occasionally required to lift and/or move up to 10 pounds and occasionally may be required to lift and/or move up to 25 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Supervisor or a Manager in PBM Operations

Potential pay for this position ranges from $64,700.00 – $97,100.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in todays health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in peoples lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.