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Rx Benefits Analyst II, Phoenix, AZ


Organization: Blue Cross Blue Shield of Arizona
Category: Professional
Location: Phoenix, AZ
Date Job Posted: November 14, 2022
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Rx Benefits Analyst II

Job Description

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Responsible for internal and external functions that support accurate claim processing for medications.

Required Work Experience

Level 1

  • 3 year Experience in pharmacy or medical field
  • 3 year Experience in prescription benefit administration

Level 2

  • 5 years Experience in pharmacy or medical field
  • 3 years Experience in prescription benefit administration
  • 1 year Experience working in vendor applications (adjudication, web tools, formulary tools)

Level 3

  • 5 years Experience in pharmacy or medical field
  • 5 years Experience in prescription benefit administration
  • 2 years Experience working in vendor applications (adjudication, web tools, formulary tools)

Level 4

  • 6 years Experience in pharmacy or medical field
  • 6 years Experience in prescription benefit administration
  • 5 years Experience working in vendor applications (adjudication, web tools, formulary tools)
  • 5 years in progressive responsibility with allocation of resources and participating in mgmt of complex projects

Required Education

  • High-School Diploma or GED

Required Licenses

  • N/A

Required Certifications

  • N/A

LEVEL 1 - PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW

  • Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
  • Support internal and external customers with information on benefits applicable to medication claims
  • Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
  • Communicate recommendations in regard to medication claim processing and benefit decisions.
  • Monitor and investigate reported medication related system issues
  • Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.

LEVEL 2 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION

  • Communicates issues identified within vendor system effectively to team.
  • Strategizes solutions for issue resolution and communicates plans to team.
  • Provides written documentation for desk levels.
  • Provides support to other team members when necessary

LEVEL 3 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON; ACTS AS SUBJECT MATTER EXPERT

  • Primary liaison for Pharmacy Management for applicable vendor applications.
  • Primary SME contact for various internal departments within BCBSAZ.
  • Builds reporting and analyzes data for benefit recommendations to management.

LEVEL 4 - LEAD - PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION

  • Works with Pharmacy Management Leadership team to identify project prioritization
  • Allocates resources to ensure required work is accomplished within defined time frames
  • Assigns Tasks to Analysts and Support Specialists as needed

ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

Perform all other duties as assigned.

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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