Benefits Configuration Analyst

Pharmacy Data Management, Inc. (Pdmi) - Poland, OH

Full-time

Remote - Poland, OH

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services

About the position

The Benefits Configuration Analyst at PDMI is responsible for managing and analyzing product-specific plan designs and benefit structures across various product lines. This role supports the Customer Success teams by ensuring accurate daily operations related to benefit design changes and system configurations. The position offers a fully remote work environment and is integral to improving healthcare quality and efficiency through collaborative efforts and innovative solutions.

Responsibilities

• Provides analysis and support for implementing new client business and ongoing maintenance of existing client business related to benefit design changes.
• Analyzes, interprets, integrates, and makes business decisions regarding system configuration.
• Develops and maintains knowledge of both the technical and operational sides of the business utilizing PDMI's proprietary claims adjudication system.
• Analyzes and implements requests for system configuration with a high degree of accuracy.
• Maintains documentation that validates system configuration.
• Ensures accurate management of plan benefits coding changes, test execution, and validation efforts of plan benefit design requests.
• Works closely with internal partners to support client needs for specific products and projects related to claims adjudication, reporting, accumulators, and eligibility.
• Engages in project teams and makes recommendations regarding process improvements and other business initiatives.
• Develops, updates, and maintains departmental procedures surrounding specific product lines.
• Shares knowledge and mentors colleagues in specific product line areas to enhance company-wide knowledge of products and services.
• Resolves issues before escalation path transitions outside of department.
• Performs quality assurance peer reviews on system configurations with a high degree of accuracy.
• Maintains service level guarantees and achieves individual performance goals around accuracy and timeliness.
• Engages in team meetings and provides input for project/issue resolution.
• Complies with standards regarding benefit design and configuration, including HIPAA and NCPDP regulations.
• Attends educational summits and/or conferences related to specific product lines.

Requirements

• Minimum four-year college degree preferred or equivalent industry experience (i.e., healthcare or insurance).
• Prior experience with benefits and compiling analytical data and reports.
• Demonstrated customer service skills.
• Background encompassing electronic claims processing preferred.
• Ability to develop a unique understanding of PDMI brand, products, and services.
• Excellent Microsoft Office skills, including Outlook, Teams, Excel, and Word.
• Very strong attention to detail.
• Excellent organizational and time management skills.
• Ability to manage multiple projects and priorities.
• Ability to understand and document system logic and processes within software programs and applications.
• Ability to understand and communicate complex concepts in simple terms.
• Troubleshooting, analytical, and issue resolution skills.
• Excellent research and follow-up skills.
• Exceptional written and verbal communication skills.
• Ability to interpret client requests and coordinate to accomplish tasks accordingly.
• Ability to build and manage effective working relationships.

Benefits

• Fully remote opportunity
• Collaborative work environment
• Opportunities for professional development
• Meaningful work contributing to healthcare quality and efficiency