Position Title: Prescription Plan Design & Escalations Analyst
Work Location: Remote
Assignment Duration: 12 Months
Shift Timings : 8 AM to 4:30 PM (MST)
Key Responsibilities:

• 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 our organization systems, procedures, forms and manuals
• Communicate recommendations in regard to medication claim processing and benefit decisions.
• Monitor and investigate reported plan set up 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.
• Resolve escalated member issues
• Research & provide recommendations for accumulations issues
• Logs all benefit setup issues on error tracking reports
• Provide monthly updates on error resolutions and impact reports
  
  ALL LEVELS
• Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
• Properly track all pharmacy benefit issues & concerns
• 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.
  
  Qualification & Experience:
• Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
• High-School Diploma or GED

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 22.00/hr.