[Hiring] Benefit Design and System Support Analyst @Southern Scripts

Role Description

The Benefit Design and System Support Analyst provides Liviniti employees and customers with comprehensive knowledge of the claim processing system. This includes answering questions and assisting with problem resolution.

• Manages tickets within a ticketing system; troubleshoots and resolves tickets that are placed in the claims processing queues in a timely manner.
• Adjudicates information on multiple software platforms.
• Enforces procedures that are put in place by the Benefit Design Supervisor, Director of Claims Processing, and other Leadership.
• Identifies and corrects Benefit Design errors within the claims processor based on client documentation, including performing financial audits on the error(s) found and determining impact for the client and/or Southern Scripts.
• Provides and potentially presents audit findings to Account Management and, on occasion, the Leadership team.
• Facilitates benefit designs for new clients within the claims processor based off of documentation.
• Communicates with the Implementation team regarding benefit designs for new clients.
• Communicates with the EDI team regarding various data files.
• Communicates with the Clinical team regarding clinical edits that are active for current clients.
• Works in conjunction with the Clinical team to input information into the claims processor and makes updates based on extensive testing.
• Communicates with the Account Management team to facilitate benefit design updates and obtain appropriate documentation for current clients.
• Assists Customer Service Representatives with troubleshooting and resolving issues within our claims processor, when appropriate.
• Works in conjunction with an external programming team to analyze and resolve programming error(s) within our claims processor.
• Participates in developing additional quality assurance for internal processes.
• Plays an active role in evaluating quality standards from an objective point of view and ensuring the proper checks and balances are applied to all parts of the Claims Processing procedures.
• Abides by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, reports the violation to the Compliance Officer and/or Human Resources.
• Attends, completes, and demonstrates competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that the job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.

Qualifications

• Associate or Bachelor’s degree preferred.
• 2 to 3 years’ previous experience working in PBM environment, health plan, pharmacy chain, or managed care services organization in a Systems or Plan Design capacity.
• Intermediate or advanced proficiency with MS Excel, Word, PowerPoint, Outlook.
• Excellent verbal and written communication skills, establishing rapport and working with others.

Requirements

• Organization.
• Time Management.
• Strong Problem-Solving Skills.
• Strong communication/collaboration skills.
• Easily adapt to and learn new technology and skills.
• Thoroughness.

Benefits

• Medical, Dental, Vision insurance.
• Disability and Life insurance.
• Employee Assistance Program.
• Generous Paid-Time Off.
• Annual Reviews and Development Plans.
• Retirement Plan with company match immediately 100% vested.