Pharmacy Analyst - Provider Services & Claims Administration

abbluecross; Alberta; On-site; CAD 42,000 - 60,000; Full time

Benefits offered by this job

Flexible hours

Job summary

Alberta Blue Cross® in Alberta is seeking an enthusiastic professional to join our Provider Services & Claims Administration team. You will process manual pharmacy claims, handle high-cost drug claims, and support education of pharmacy providers on submissions and reversals.

With a focus on accuracy and timely adjudication, you will perform QA checks, assist with system testing, analyze complex inquiries, track reporting, and look for workflow improvements in a flexible work style environment.

Qualifications

• Demonstrated commitment to delivering superior customer service and maintaining stakeholder relationships.
• Knowledge of pharmacy benefit design and claim adjudication standards is an asset.
• Strong organizational skills with the ability to manage a heavy workload and meet tight timelines.

Responsibilities

• Process manual pharmacy claims, including high-cost claims, accurately and on time.
• Perform quality assurance checks on adjudication results and complete required adjustments.
• Educate pharmacy providers on claims submissions and reversals, including collection of monies.
• Perform system testing and research complex inquiries or unique situations.
• Track and report on work initiatives and monitor individual production to meet timelines.
• Suggest workflow improvements to increase efficiency and innovation.

Skills

Customer service

Pharmacy claims processing

Quality assurance

Time management

Communication

Tools

Microsoft Word

Excel

Outlook

Access

Job description

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 to join our Provider Services & Claims 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.

A criminal record check satisfactory to Alberta Blue Cross will be required as a condition of employment, following a conditional offer.