Elevance Health - Indianapolis, IN
posted 2 months ago
Full-time - Mid Level
Indianapolis, IN
11-50 employees
Insurance Carriers and Related Activities
About the position
The Pharmacy Benefit Auditor at CarelonRx is responsible for analyzing pharmacy benefit coding systems to ensure compliance with business criteria. This role focuses on quality reviews, data analysis, and collaboration with various departments to enhance pharmacy plan accuracy. The auditor serves as a subject matter expert, providing feedback and guidance to team members while driving service quality excellence in pharmacy operations.
Responsibilities
- Analyze pharmacy benefit coding systems against business criteria.
- Conduct quality reviews of pharmacy benefits across multiple lines of business.
- Provide written and verbal feedback to peers and stakeholders.
- Collaborate with other departments to identify areas for improvement in pharmacy plan builds.
- Drive service quality excellence by evaluating the accuracy of pharmacy plan builds.
- Serve as a subject matter expert on pharmacy benefits and coding systems.
- Consult with business partners on pharmacy benefit program implementation.
- Recognize and design solutions for complex business needs.
- Analyze data and make recommendations for changes based on operational procedures.
Requirements
- Bachelor's degree and a minimum of 5 years of business analysis experience, or equivalent education and experience.
- Strong analytical skills and experience in pharmacy operations.
Nice-to-haves
- CPhT certification preferred.
- Experience in pharmacy plan benefit coding and quality review.
- In-depth understanding of pharmacy benefit design.
- Demonstrated success in training and team lead roles.
- Knowledge of systems capabilities including Excel, Word, Visio, Outlook, PowerPoint, MS Teams, SharePoint, JIRA, and Salesforce.
- Strong oral and written communication skills.
- Experience with reporting and analytics.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical, dental, and vision insurance
- Short and long-term disability benefits
- 401(k) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
