Pharmacy Analyst- Provider Services

ABC Benefits Corporation; Canada; Remote; CAD 60,000 - 80,000; Full time

Job summary

A healthcare services provider in Canada is seeking a Pharmacy Analyst to manage pharmacy claims and ensure quality assurance. The ideal candidate will deliver superior customer service, demonstrate strong problem-solving skills, and work in a flexible environment. Proficiency in Microsoft Office is essential. This role provides an opportunity to contribute to health coverage for over 1.8 million members.

Qualifications

• Demonstrated commitment to customer service and effective relationships.
• Strong judgment in decision-making and high accuracy in work.
• Ability to manage heavy workloads and meet tight deadlines.
• Willingness to adapt to changing priorities and processes.
• Ability to work with minimal supervision in a flexible work style.

Responsibilities

• Process manual pharmacy claims accurately and timely.
• Perform quality assurance on claim adjudication results.
• Assist pharmacy providers with claims submissions.
• Research and resolve complex inquiries.
• Monitor production to meet output and timelines.

Skills

Problem-solving abilities

Attention to detail

Organizational skills

Time management

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Access

Job description

Pharmacy Analyst- Provider Services page is loaded

Pharmacy Analyst- Provider Services

Apply locations Work From Home Alberta time type Full time posted on Posted 9 Days Ago job requisition id R898

Alberta Blue Cross is an Alberta based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision.

Working at Alberta Blue Cross means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth.

OVERVIEW:

Alberta Blue Cross is currently seeking an enthusiastic individual for a temporary position to join our Pharmacy Provider Agreement & Administration team working in a flexible work style arrangement. With the support of the Team Manager, and under the guidance of a Team Lead, this position is responsible for day-to-day activities related to processing manual pharmacy claims, managing complex pharmacy drug claim inquires, and adjusting direct bill drug claims. This is a detailed position, requiring accuracy and efficiency, to ensure that work objectives and timelines are met, and our reputation for excellent customer service is maintained.

WHAT YOU WILL DO:

• Process manual pharmacy claims, including high-cost drug claims, ensuring claims are adjudicated accurately in accordance with drug benefit plan coverage, and in a timely manner.
• Perform quality assurance checks on claim adjudication results, and complete claim adjustments when necessary.
• Assist and educate pharmacy providers with claims submissions and reversals, including collection of monies from pharmacy providers.
• Perform system testing.
• Research and analyze information to resolve complex inquiries or unique situations.
• Track and complete reporting on work initiatives.
• Monitor individual production to ensure acceptable quantity of output and timelines are met.
• Make suggestions to improve workflows, increase efficiency, and be innovative.
• Be willing to occasionally work flexible hours.

WHAT YOU WILL HAVE:

• Demonstrated commitment in delivering superior customer service, including establishing and maintaining effective working relationships with internal and external stakeholders.
• Strong problem-solving abilities and attention to detail are critical, demonstrating the ability to use good judgment in evaluating and decision-making, and completing work with a high degree of accuracy.
• Excellent organizational and time management skills with the ability to prioritize tasks, manage a heavy workload, and meet tight timelines.
• Demonstrated willingness and ability to adapt to changing priorities and processes.
• Demonstrated ability to work with minimal supervision, with a strong sense of accountability, in a flexible work style arrangement.
• Computer proficiency with Microsoft Word, Excel, and Outlook is essential. Exposure to Access would be beneficial.
• Knowledge of the pharmacy industry, including drug plan design and claim adjudication standards, is an asset.

This position will remain open until a suitable candidate is selected.

Alberta Blue Cross is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, apply online at careers.ab.bluecross.ca

About Us

Alberta Blue Cross is an Alberta based not-for-profit, dedicated to delivering exceptional customer experience and community leadership. We are committed to providing the best health coverage to over 1.8 million members and take an active role in promoting the wellness of all Albertans.

We believe in what we do—and place trust in our employees to deliver our vision.

* The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan. † Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association.