This position specializes in the analysis and application of advanced and complex level benefit design requirements. A successful Senior Analyst will ensure a high level of quality and accuracy through benefit configuration, test execution and validation efforts while serving as a subject matter expert on benefits and claim adjudication system coding setup.

• Designs, analyzes and implements benefit coding change requests with a high degree of accuracy.


• Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution.


• Responsible for managing less standardized plan design concepts, clients and programs from a coding, testing and validation perspective.


• Facilitates conversations within the team to define client intent or program setup.


• Facilitates and troubleshoots inquiries amongst multiple internal and external teams until resolution and implementation.


• Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specifications and data flow from which programs are developed and coded.


• Actively participates in and contributes to daily communications, team meetings and project/issue resolution.


• Participates in and leads internal calls with clients to understand the intent of requested benefit changes.


• Identifies, analyzes and presents to leadership creative solutions for process improvement activities regarding benefit configuration.


• Analyzes new business requirements for benefit design changes to establish the appropriate solution.


• Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests.


• Maintains customer documentation that validates configuration.


• Efficiently and effectively distributes tasks, using clear and concise instructions and expectations.


• Completes deliverables independently and within an agile team setting


• Coordinates responses to both external and internal audits. Ensures workflows support compliance and identifies when audit protocols need to be refreshed to more accurately capture day-to-day procedures. Evaluates audit findings and implements new processes to bring Benefit Configuration into compliance.


• Other duties as assigned.

Responsibilities
2+ years of experience in benefit plan configuration/analysis.
Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application.
Advanced working knowledge of Microsoft office products (specifically Word, Access, Excel), including running queries and macros.
Advanced knowledge of interpreting and understanding prescription benefits.
This role requires strong attention to detail, critical thinking and analytical skills
Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
Strong sense of urgency leading to the timely completion of all projects, training and assignments.

General Job Information

Title
Pharmacy Benefits Configuration Coordinator

Grade
22

Work Experience - Required
Benefit Plan Configuration

Work Experience - Preferred

Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelors

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.