Specialty & Home Delivery Program Analyst - Remote

Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Job Description

The Specialty & Home Delivery Program Analyst is responsible for serving as a subject matter expert on our Home Delivery and Specialty pharmacy partners and Pharmacy Match product which may include implementations, projects, claims & performance guarantee monitoring, and testing. This position is responsible for working with internal and external clients and serving as an escalation and mentoring resource for inquiries and issues.

Responsibilities

• Represent Strategic Partnerships as subject matter expert (SME) on both internal and external projects, participating in all relevant functions on project lifecycle as assigned
• Perform daily claims monitoring and data validation activities
• Research and analyze information by employing analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate data into usable internal and/or client facing reports
• Respond to inquiries related to specific job function process or support systems and provide documentation and tracking to resolution
• Partner with Prime's Clients to identify, problem solve, and execute corrective measures
• Provide backup support to various roles within department with ability to serve as short-term stand-in for each position, when necessary
• Other duties as assigned

Education & Experience

• Bachelor's degree in IT, Business, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 2 years of work experience in claims processing or project lifecycle, or related roles in the healthcare or PBM industry
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Flexibility in job duties with ability to work on multiple tasks simultaneously
• Strong verbal, written, and interpersonal communication skills
• Strong analytical, organizational, time management, and problem-solving skills
• Strong attention to detail

Preferred Qualifications

• PBM industry knowledge
• 2 years of experience working with RxClaim

Physical Demands

• Ability to travel up to 10% of the time
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
   

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.