Specialty Benefits Analyst (Remote)

Resp & Qualifications

PURPOSE:
The incumbent is responsible for fully understanding necessary functions and processes to support Specialty Business lines (consisting of Pharmacy) across the organization, assessing business solutions that identify and strengthen the operational effectiveness and enhance member and customer experience. This position will be dedicated to one primary specialty business line. The incumbent will be required to be an active participant in activities that support internal and external customers and their projects and inquiries. The Analyst will serve as a Subject Matter Expert for the department and consult on matters that impact business area teams. Incumbent will be crossed trained to support medical drug pricing.

ESSENTIAL FUNCTIONS:

Production Support
o Address benefit inquiries from all areas of the company for assigned product lines.
o Research and resolve issues that have been reported to team through emails and other means in a timely manner.
o Serve as a subject matter expert for assigned specialty products and services and how they are built/maintained on the CareFirst platforms.
o Provide support for the successful completion of other related tasks, such as daily maintenance of member issue logs, system control files, benefit files, and tracking/updating documentation.
o Review, edit, and perform analysis of business systems, processes, and documentation making necessary corrections to improve the performance and accuracy of existing configuration builds, processes, and documentation.
o Create new policies or procedures and update the existing policies or procedures.
o Utilize team controls and processes for production systems support and monitoring, which includes issue analysis, tracking, and resolution.
o Ensure successful completion of day-to-day changes, corporate initiatives, and other projects by completing the necessary activities to ensure business accuracy.
o Meet critical deadlines and/or timely delivering/providing the appropriate level of analysis and/or documentation to support internal or external audit requirements/specifications.
Business Development Support
o Actively participate in planning sessions to ensure that the teams tactical and strategic operational goals are aligned with other CareFirst departments and clients.
o Provide input to the development of project plans for day-to-day changes, corporate initiatives, and other projects.
o Provide feedback for development of resource estimates, timeframes, and provide input to cost/benefit analysis that will be used to develop ROI business cases and budgets for initiative projects.
o Support and/or perform corporate processes for systems and process change management, spanning request submission, review, validation, prioritization, scheduling, and status reporting.
o Provide support for project configuration, testing (i.e. User Acceptance and scenario testing) and implementation where required.
o Review corporate communications, promotional literature, internal documents, ecommerce documents and training materials to ensure accuracy and regulatory compliance.
System and Process Improvements
o Proactively participate/lead in the technical research and business process improvements that help identify opportunities for improved systems and/or business processes.

SUPERVISORY RESPONSIBILITY:
The incumbent has no direct reports but may review the work of Contractors and may serve as a task leader for projects.

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years experience in the health insurance/healthcare industry, with knowledge of benefit products and self-funded rating arrangements.

Preferred Qualifications:

• Previous experience in a business analyst capacity for a health care organization.
• Previous experience working with stop loss.
Previous experience in the self-funded market.

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Knowledge, Skills and Abilities (KSAs)

• Must have the ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to run reports, business correspondence, and procedure manuals.
• Ability to successfully manage multiple projects, tasks and priorities.
• Ability to be thorough while maintaining efficiency and accuracy.
• Demonstrated knowledge and understanding of stop loss.
• Ability to analyze essential facts, make timely and sound decisions, make recommendations and resolve performance and job-related issues. Demonstrated desire to share knowledge and work as a team.

Salary Range: $50,904 - $101,101

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

PBM Operations

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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