Specialty & Home Delivery Program Analyst - Remote

Lensa; Bismarck (ND); Remote; USD 59,000 - 94,000; Full time

Job summary

An established industry player is looking for a Specialty & Home Delivery Program Analyst to join their remote team. This role is essential in ensuring the smooth operation of pharmacy services by monitoring claims, analyzing data, and providing expert support to clients. With a focus on problem-solving and communication, you'll play a vital role in enhancing healthcare delivery. If you're passionate about making a difference and have a background in healthcare or project management, this opportunity is perfect for you. Join a company that values your contributions and supports your professional growth.

Qualifications

• 2 years of experience in claims processing or related roles in healthcare.
• Bachelor's degree or equivalent experience required.

Responsibilities

• Monitor daily claims and validate data for accuracy.
• Analyze data to identify errors and assess financial impacts.

Skills

Analytical Skills

Communication Skills

Problem-Solving Skills

Organizational Skills

Education

Bachelor's degree in IT, Business, Science, or related field

High School diploma or GED

Tools

RxClaim

Job description

Specialty & Home Delivery Program Analyst - Remote

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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Specialty & Home Delivery Program Analyst - Remote

Job Description

The Specialty & Home Delivery Program Analyst is responsible for serving as a subject matter expert on our Home Delivery and Specialty pharmacy partners and Pharmacy Match product. This may include implementations, projects, claims & performance guarantee monitoring, and testing. The position involves working with internal and external clients and serving as an escalation and mentoring resource for inquiries and issues.

Responsibilities

• Represent Strategic Partnerships as a subject matter expert (SME) on internal and external projects, participating in all relevant project lifecycle functions.
• Perform daily claims monitoring and data validation activities.
• Research and analyze information using analytics and data science techniques to validate errors, isolate impacted claims, reprocess claims, and assess financial impact to members, health plans, and pharmacies; translate data into reports.
• Respond to inquiries related to processes or support systems, providing documentation and tracking for resolution.
• Partner with Prime's clients to identify issues, problem solve, and implement corrective actions.
• Provide backup support to department roles, serving as a short-term stand-in when necessary.
• Other duties as assigned.

Education & Experience

• Bachelor's degree in IT, Business, Science, or related field, or equivalent experience; HS diploma or GED required.
• At least 2 years of work experience in claims processing, project lifecycle, or related roles in healthcare or PBM industry.
• Must be eligible to work in the U.S. without sponsorship.

Additional Qualifications

• Flexibility to handle multiple tasks.
• Strong communication skills.
• Excellent analytical, organizational, and problem-solving skills.
• Attention to detail.

Preferred Qualifications

• Knowledge of PBM industry.
• Experience with RxClaim (2 years).

Physical Demands

• Up to 10% travel.
• Constant sitting, handling, talking, and hearing.
• Frequent reaching.
• Occasional standing, walking, stooping, kneeling, crouching.
• Occasional lifting up to 25 pounds.
• Vision abilities including near, far, color, peripheral, and depth perception.

All employees must comply with security responsibilities, legal, regulatory, and internal policies.

Potential pay ranges from $59,000 to $94,000 based on experience and skills.

For benefits details, visit our Benefits Page and click on 'Benefits at a glance.'

Prime Therapeutics is an equal opportunity employer, encouraging diverse candidates to apply without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability, age, veteran status, or other protected classes.

We welcome applicants with different backgrounds, including those requiring accommodations or with records of arrest or conviction, in accordance with law.

Contact Human Resources at 1.866.469.1257 or [e-mail] for accommodations.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Management and Manufacturing

Industries

• IT Services and IT Consulting