Scope of Responsibilities: Responsible for the entry of new client data or changes to existing clients into the PBM adjudication platform. Works closely with the Benefit Operations Supervisor in ensuring the team’s goals are met. 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. The position will act as a lead role within the Benefit Operations Specialist team and be a liaison to management and other organization leaders while still performing the daily functions of a Benefit Operations Specialist. 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.

• Perform benefit changes and updates for existing ProAct business in all appropriate systems.
• Act as a leader for the Benefit Operations Specialist team., facilitate meetings with all Benefit Operations Specialists.
• Assist the Benefit Operations Supervisor in coordinating strategic approach to projects and audits as needed.
• Responsible for coordination of training of new BOM team members.
• Identify potential opportunities of process improvement in BOM team’s performance and work with the Benefit Operations Supervisor to address any issues.
• 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.

Education:

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

Experience:

• Required: 1 year experience using the RxIQ claims adjudication platform
• Preferred: 2 Years experience with Health Care, Insurance and /or Account Management

Compensation:

$22.00 - 24.00 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.