„Acrisure“ teikia draudimo, rizikos valdymo ir finansines paslaugas privatiems asmenims, įmonėms ir darbuotojams. Jos paslaugos apima asmens ir komercinį draudimą, būsto paskolas, darbuotojų naudų programas, kibernetinį saugumą, valdomas IT paslaugas ir perdraudimą, o pastarojoje srityje daugiausia dėmesio skiriama tarptautinei veiklai. Įmonė derina konsultavimo kompetenciją su technologijomis grindžiamais sprendimais įvairiame paslaugų portfelyje, taip pat investuoja į partnerystes su bendruomenėmis ir informavimo veiklą.
Pharmacy Benefits Claims Consultant
Resolve pharmacy benefit claims for self-funded employer health plans by investigating discrepancies and coordinating with stakeholders. Support accurate claims processing and improvements to plan performance and cost management.
Aprašymas
- Investigate and resolve pharmacy benefit claim issues and inquiries.
- Review claim outcomes to find discrepancies, processing errors, and opportunities for corrective action.
- Coordinate on complex claim concerns with pharmacies, PBMs, TPAs, carriers, brokers, and plan sponsors.
- Research eligibility, benefit design, prior authorization rules, and plan provisions to determine claim outcomes.
- Track payment accuracy and compliance with contractual and regulatory requirements.
- Help audit and reconcile pharmacy claims data.
- Support client implementations and benefit plan changes.
- Document claim investigations, resolutions, and communications.
- Work with Account Management, Clinical, and Operations teams to deliver coordinated service.
- Explain claim processes, pharmacy benefits, and cost management strategies to members.
- Keep current with pharmacy benefit trends, industry regulations, and healthcare legislation affecting claims administration.
- Carry out other assigned duties.
Reikalavimai
- Preferred: bachelor’s degree in business, healthcare administration, finance, insurance, public health, or a related field.
- At least three years of experience in health insurance, pharmacy benefits, claims administration, healthcare operations, or a related industry.
- Experience with self-funded health plans, PBMs, TPAs, or pharmacy benefit programs is preferred.
- A comparable combination of education and experience may be considered.
- Strong spoken and written communication skills.
- English and Spanish fluency is preferred.
- Solid knowledge of healthcare claims processing and pharmacy benefit administration.
- Knowledge of prescription drug benefit structures, formularies, specialty pharmacy programs, and utilization management.
- Strong analytical and problem-solving abilities.
- Able to assess urgency independently, prioritize work, research and resolve issues, determine when to escalate, follow through promptly, and communicate clearly.
- Careful attention to detail and commitment to accuracy.
- Strong customer service and relationship management skills.
- Professional communication with members, pharmacies, providers, and internal teams.
- Proficiency in Microsoft Office, especially Excel.
- Experience with claims adjudication systems, reporting platforms, and healthcare data is preferred.
- Able to learn quickly and adapt.
- Strong organizational and documentation skills.
- Comfortable working on-site to support collaboration, team leadership, and cross-functional partnerships.
Privalumai
- Comprehensive medical insurance
- Dental insurance
- Vision insurance
- Life and disability insurance
- Fertility benefits
- Wellness resources
- Paid sick time
- Generous paid time off and holidays
- Employee Assistance Program (EAP)
- Complimentary Calm app subscription
- Immediate vesting in a 401(k) plan
- Health Savings Account (HSA) options
- Flexible Spending Account (FSA) options
- Commuter benefits
- Employee discount programs
- Paid maternity leave
- Paid paternity leave, including for adoptive parents
- Legal plan options
- Pet insurance coverage