Perform claims diagnosis to identify claims impacted by plan benefit changes
Review parameters of an issue and run AS400 queries to identify impacted claims
Pull impacted claims for R&R and complete manual analysis in Excel
Identify financial impacts to clients, members, and pharmacies due to benefit coding errors
Manage individual queue of multiple projects in a fast-paced environment
Collaborate with Sales, Account Management, Client Audit, Benefits, Clinical, Rebates, and other teams to manage and coordinate work

1+ years of healthcare experience
1+ years of Excel experience
Understanding of data sets, tables/files, queries, joins, and other database concepts
Strong customer service focus that includes both internal and external customers
Excellent verbal and written communication skills
PBM Industry and plan design
RxClaim adjudication or benefits strongly preferred
Experience with CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or other relevant experience highly desired
Business operational experience that includes high volume transactional experience
Ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions

Financial Operations Analyst

Key skills