Benefits Analysts (Pharmacists)
Job ID: 102905 Job Views: 287 Posted: 2012-03-08 Location: Philippines Quezon City, Metro Manila
Job Description
Benefit Analysts
Responsibilities:
o Analyze benefit requests and secure all necessary data to ensure appropriate. implementation based on applied logic of RxCLAIM (by SXC) pharmacy claim adjudication system.
o Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.
o Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system.
o 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 turn around times
? Adhere to all documentation standards within the department.
? Assist with the development of process improvements for the department.
? Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal department.
? Participate in team meetings.
? May be assigned to work on special projects and business initiatives.
Performance Standard
? Ability to maintain an accuracy rate of 98% or better
? Adherence to company attendance policy
? Able to work independently
? Completes assigned projects on time
Skills:
? Microsoft Office proficiency Word and Excel, specifically Advanced Excel skills -- must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting;
? Strong written and verbal skills;
? Detail-oriented;
? Superior organization skills;
? Ability to work on multiple project simultaneously; and
? Excellent analytical skills.
Qualifications:
? Bachelor's Degree in Pharmacy;
? Registered Pharmacists
? Certified pharmacy technician preferred;
? 2+ years of RxCLAIM (by SXC) experience (desired); and/or
? 2+ years PBM or retail pharmacy experience (required).
http://careers.unitedhealthgroup.com
Location: 24th Floor, IBM Plaza, 8 Eastwood Ave., Eastwood City Cyberpark, E. Rodriguez Jr. Ave., Libis, Quezon City
How to apply: Send CVs to Kathleen_Resulta@uhgrecruitmentservices.com, walk-in, send sms or call 0917-5790508.
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Company Information
UnitedHealth Group
24th Floor, IBM Plaza, 8 Eastwood Ave., Eastwood City Cyberpark, E. Rodriguez Jr. Ave., Libis, Quezon City Quezon City Metro Manila Philippines
Contact Name: Kathleen Resulta
Phone: 0917-5790508
Web: http://careers.unitedhealthgroup.com
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