Job Description
Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . As a Pharmacy Benefit Analyst , you’ll serve as the technical subject matter expert supporting the Pharmacy and Product Configuration teams on Pharmacy Benefit Manager (PBM) benefit coding and programs. You will research and analyze benefit configuration needs, troubleshoot process and system issues, and partner with internal teams and external vendors to ensure accurate PBM set-up. In this role, you’ll validate claim adjudication and plan configuration through quality assurance and testing, provide oversight of PBM data interfaces, and assess configuration changes for compliance with applicable state and federal regulations. You’ll also respond to inquiries, recommend standard and custom configuration options, and identify and escalate potential risks impacting benefit configuration. This is a high‑impact individual contributor role where you’ll work in a small, highly visible team, with your work directly affecting how pharmacy benefits function for members and providers. What you’ll do: Provide technical support and partners with PBM vendor (Express Scripts), Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding, interpretation of pharmacy benefits and new pharmacy product builds. Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been completed appropriately and reviews system generated outputs to validate outcomes. Provide oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct. Research and provide direction to team on complex PBM benefit coding and compliance issues. Provide input to PBM vendor, IT and teams on custom benefit requests and make recommendations for alternative approaches. Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing. Collaborate with cross functional Premera teams (sales, system configuration, claims, contract services, group set-up, membership and billing, customer service), on feasibility and processing requirements for new and custom products and services, to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues. Create, maintain and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work and mitigate any risks. Develop processes and procedures for new and changing requirements. Develop training content and provide instruction to staff both 1:1 and in classroom setting. Work collaboratively with training staff in developing training programs. Monitor delivery and tracking for wide range of inquiries, activities and workload within team providing direction to team members and on-going status reports to leadership. Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database. What you’ll bring: Bachelor’s degree or four years equivalent experience (Required). Washington Pharmacy technician License (Preferred). 3 years PBM technical experience in benefit coding or claims adjudication or related area which includes at least one year experience in PBM benefit configuration or equivalent (Required). In-depth knowledge of pharmacy benefit coding (Preferred). Previous experience in Premera product configuration (Preferred). Previous experience troubleshooting production issues within claims or customer information systems or database