Benefit Validation Analyst

Accredo Health Saint Louis , MO 63150

Posted 2 weeks ago

POSITION SUMMARY

The Testing Analyst II is responsible for the management of new and existing client testing to validate benefit set-up based on client's intent and expectation. The role analyzes client intent and creates validation and test scenarios, executes validations/tests and analyzes results. This will cover all functions necessary to implement a client, including, but may not be limited benefits, clinical, pricing, and coverage for all lines of business in scope for benefit validation (Health Plan clients, commercial clients, MedD clients, book of business projects, etc.). The role will require considerable cross-functional communication to effectively monitor the daily status of client implementations and plan changes. This role collaborates with internal partners to obtain necessary information to perform the work, request intent clarifications, identify setup issues, and bring closure to our validation/testing activity.

ESSENTIAL FUNCTIONS

  • Manage new and existing client testing to validate benefit set-up based on clients' intent and expectation.

  • Troubleshoot and resolve issues in a timely manner to meet effective dates.

  • Manage Pr-Implementation Audit and Claim Compare projects defining scope, milestones, and project plan.

  • Execute that project plan and communicate results in a client/vendor facing environment.

  • Considerable cross functional communication to effectively monitor the daily status client implementations and assist in collaboration efforts with internal partners.

  • Attend client meetings and create custom test cases when applicable.

  • Relationship building and daily partnership with Implementation, CBA, and Eligibility.

  • Create and maintain client specific documentation related to benefit testing requests.

  • Provide on-the-job training and mentoring to less experienced team members to improve their understanding and skills.

  • Work collaboratively with other team members to ensure that best-practices are shared.

QUALIFICATIONS

  • Bachelor's degree in related field or 8 to 11 years of experience.

  • 2-5 years relevant experience with Bachelor's Degree or Master's degree and 0-3 years of relevant experience.

  • Proficiency in Microsoft Office Suite strongly preferred.

  • Advanced problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions.

  • Demonstrate ability to prioritize work load and meet project deadlines.

  • Ability to learn quickly.

  • Adapt in a dynamic work environment and make independent decisions.

  • Extremely detail oriented.

  • Strong customer service focus.

  • Excellent oral and written communication skills.

  • Willingness to work a flexible schedule, be on call to accommodate project deadlines.

ABOUT THE DEPARTMENT

The mission of PBM Services is to meet market needs for speed, flexibility and reliability, while driving and influencing best operational practices. PBM Services includes Client and Benefit Administration, Manual Claims Processing, Eligibility, Quality Control, Implementation and the Client Service Center. These centralized functions support the client lifecycle throughout the enterprise, helping to "get it right the first time" and thereby increasing client satisfaction and reducing waste and the cost of rework.

ABOUT EXPRESS SCRIPTS

At Express Scripts, we dare to imagine a better health care system, and we're driven to make it happen. Where some see obstacles, we see possibilities. We're challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.

We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.

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Benefit Validation Analyst

Accredo Health