Claims Pharmacy Benefit Manager Accumulator Specialist

The Claims Pharmacy Benefit Manager (PBM) Accumulator Specialist) serves as the subject matter expert for Pharmacy Benefit Manager (PBM) accumulators. Responsibilities include researching and resolving accumulator discrepancies, processing retroactive changes and cancellations, and maintaining claims processing knowledge.

“This position is eligible to work onsite, remote, or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Real World Experience: You will work hand in hand with our team in learning our business and applying your classroom learning.
• Networking Opportunities: Participate in our corporate intern program and network with other interns at BCBSKS to enhance your learning opportunity.

Compensation

$23.00 23.90
Non- Exempt 12
• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

What you’ll do

Responsibilities: 

• Review and analyze PBM Out of Balance reports weekly, identifying and resolve discrepancies.
• Compare PBM and claims system data to determine corrective actions.
• Run queries and collaborate with IT and PBM teams to resolve errors.
• Communicate with internal teams and PBM via email, phone, and meetings.
• Adjust overstated accumulator balances weekly.
• Process group accumulator adjustments.
• Participate in PBM conference calls and internal meetings.
• Analyze and suggest process improvements.
• Finalize and adjust claims, ensuring accuracy.
• Work daily system-generated reports for claims control.
• Maintain production, accuracy, and compliance standards.
• Assist with accumulator-related testing.
• Ensure confidentiality, compliance, and security policies are followed.

What you need

Knowledge/Skills/Abilities

• PBM system experience preferred.
• Strong verbal, written, and interpersonal skills.
• Ability to interpret contractual language and benefit coding.
• Excellent organizational, multitasking, and problem-solving skills.
• Proficiency in claims systems, membership systems, imaging workflow, QMF, PBM systems, and Microsoft Office.
• Strong math, reasoning, and communication skills.
• Proven record of reliability and minimal unscheduled absences.

Education and Experience: 

• High school diploma or equivalent.
• 3 years of claims processing experience with advanced accumulator knowledge

Physical Requirements

• Office setting, with possible remote or hybrid work opportunities depending on the department.
• Some meetings, trainings, demonstrations, etc. require in person attendance.
• May involve long periods of time working on a computer.

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package:
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals