Benefit Operations Specialist

Overview

Scope of Responsibilities:  Responsible for the entry of new client data or changes to existing clients into the PBM adjudication platform.  Translates client benefit needs into the PBM platform and all associated testing to ensure accurate and efficient data entry and administration.  Provides insights and feedback to assist in updates to the platform.  Expected to partner with necessary entities in order to effectively input, audit and adjust within the adjudication platform.

 

Job Summary: Perform day-to-day operations supporting ProAct’s adjudication platform and the Benefit Operations Supervisor.  Coordinate and leverage support from resources within and external to ProAct as needed in order to input, audit, and adjust data within the adjudication platform.

Responsibilities

• Perform benefit changes and updates for existing ProAct business in all appropriate systems.
• Perform quality control audits on a regular basis.
• Expected to meet all performance standards as set by BOM.
• Provide routine updates to our formulary and benefit configurations as designated by BOM, via approved communication channels such as Clinical, Pricing, Benefit Review Team, Eligibility, and Implementation departments.
• Support the coordination of monthly, quarterly, and annual management reports as designated by BOM to support growing business needs.
• Attend, participate and contribute to adjudication platform meetings and discussions.
• Responsible for completing all mandatory and regulatory training programs
• Perform other duties as assigned

Qualifications

Education:

• Required: Minimum High School Diploma or GED
• Preferred: AS Degree or Higher in Business Administration, Marketing or related field

 

Experience:

• Preferred: 2 Years experience with Health Care, Insurance and /or Account Management

 

Compensation

 

$17.50 - 20.00 per hour

 

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.  

 

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.