Hybrid Pharmacy Benefits Configuration Specialist

Page Mechanical Group, Inc.; Portland (OR); Hybrid; USD 50,000 - 62,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health in Portland, Oregon is seeking a Benefits Analyst to support benefits configuration and claims analysis. This hybrid, full-time role works with the department lead to interpret data, improve workflows, and ensure accuracy in processing and auditing. Strong PBM knowledge and Excel/Word proficiency are essential for success.

The position offers competitive benefits, growth opportunities, and a collaborative work environment with a focus on quality and diversity.

Qualifications

• AA degree from an accredited college; four years of qualifying experience may substitute.
• Experience in claims processing administration preferred.
• Working knowledge of PBM operations and pharmacy benefits terminology.
• Ability to read, analyze and interpret policies and government regulations.
• Strong analytical and organizational skills with attention to detail.
• Proven ability to prioritize tasks and handle confidential information.

Responsibilities

• Code new plans and changes into third-party PBM database and internal systems.
• Oversee renewal processes and code new, unique group benefits.
• Conduct ongoing coding maintenance and timely updates.
• Audit new and existing plan designs via QC reports.
• Coordinate plan changes with internal and external partners.
• Maintain test claims and perform formulary updates as needed.
• Analyze claim forms against plan documents for accuracy.

Skills

AA degree

Analytical skills

PBM claims processing knowledge

Excel

Word

Ability to read and interpret policies

Communication skills

Research and problem solving

Education

AA degree from an accredited college

Tools

PBM systems

Microsoft Office

Excel

Word

Database concepts

Job description

Moda Health in Portland, Oregon is seeking a Benefits Analyst to support benefits configuration and claims analysis. This hybrid, full-time role works with the department lead to interpret data, improve workflows, and ensure accuracy in processing and auditing. Strong PBM knowledge and Excel/Word proficiency are essential for success.

The position offers competitive benefits, growth opportunities, and a collaborative work environment with a focus on quality and diversity.