Benefits Config Specialist I — PBM System Expert & QA

PharmPix Corporation; United States; On-site; USD 42,000 - 64,000; Full time

Job summary

PharmPix is seeking a Benefits Configuration Specialist I to set up client benefit rules in the OneArk system, test claims, and perform QA Reviews. You will serve as a primary contact for clients and internal teams, ensure accurate configurations, and help implement new benefit plans for PharmPix clients.

The role requires 1 year in PBM/health plan or retail pharmacy, strong problem solving, and full bilingual proficiency in English and Spanish. Evening/weekend work may be required.

Qualifications

• Pharmacy Technician Associate Degree or equivalent professional experience.
• Fully bilingual English and Spanish.

Responsibilities

• Perform accurate client benefit set up for all business rules for PharmPix clients.
• Implement new and maintain existing benefit plans, rates, and networks in the OneArk system.
• Properly enter test claims to verify business rules set up in the system.
• Perform quality assurance reviews on set up performed by other team members to ensure accuracy.
• Point of contact for both internal and external customers for system functionality and claim research questions.
• Become Subject Matter Expert on OneArk functionality to support the Operational areas and backend clients.
• Analyze client system requests and work to accommodate within existing systems before having to recommend system enhancements.
• Identify discrepancies, inaccuracies, and unintended consequences, and take corrective action.
• Research and respond to claims processing and system configuration inquiries from internal departments and backend clients.
• Proactively identify setup issues and escalate for immediate review and resolution.
• Support all Quality Management Program initiatives.
• Perform other duties as assigned.

Skills

Detail orientation

Highly organized

Pharmacy terminology

Multi-priority management

Microsoft Office

Initiative & judgment

Communication skills

Education

Pharmacy Technician Associate Degree

Puerto Rico Board of Pharmacy Technician Certification

Tools

Microsoft Office

Job description

PharmPix is seeking a Benefits Configuration Specialist I to set up client benefit rules in the OneArk system, test claims, and perform QA Reviews. You will serve as a primary contact for clients and internal teams, ensure accurate configurations, and help implement new benefit plans for PharmPix clients.

The role requires 1 year in PBM/health plan or retail pharmacy, strong problem solving, and full bilingual proficiency in English and Spanish. Evening/weekend work may be required.