San Diego, CA 92122 | Temporary to Permanent
JOB #: 18042001- SDIT
JOB DESCRIPTION: The Configuration Specialist serves as a specialist in configuring client’s pharmacy, formulary and benefit designs under direction of the Configuration Analyst. This role assists Configuration Analysts with supporting client needs regarding changes to benefit plan configurations, providing prompt information regarding service failures, and resolving issues.
• Applies pharmacy, formulary and benefit configuration to effectuate change as specified in the Implementation Questionnaire or submitted change requests
• Ensures assigned due dates for submitted change requests are met
• Troubleshoots and performs research on basic claims adjudication issues or inquirie
• Acquires a thorough understanding of client’s system logic for claims adjudication, system constraints, conflicting benefit logic configurations, benefit coding table designs, plan – group – pharmacy carrier to benefit linking, to ensure proposed design satisfies the intended solution
• Uses standardized methodology to ensure that appropriate rationale exists for non-standard designs and that all efforts are undertaken to prevent inefficient and non-sustainable configuration structures
• Reviews results of in-unit testing in order to validate new plan configurations
• Assists in creating and maintaining documentation of clients’ plan designs, detailing any custom maintenance processes and configuration best practices
• Includes documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components
Salary Range and Bonus Potential:
• Previous healthcare or PBM experience desired. Experience with pharmacy or medical claims analysis desired. In-depth drug knowledge and terminology is a plus.
• Computer Skills
• Strong proficiency with MedAccess, Microsoft Office Suite especially Excel (ability to perform advanced functions such as VLookUp, KDiff) and Word, to create complex documents and analyze data.
• Strong Interpersonal and Customer Skills
• Bonus to have SQL database exposure
• Education and/or Experience
• Bachelor's degree (B.A.) from four-year College or university or a minimum of three (3) years related experience and/or training; or equivalent combination of education and experience.