Insight Global is seeking a Network Pricing Data Analyst to join one of our large PBM clients. This individual will be responsible for research and interpretation of benefit requirements necessary to support new and existing benefits and product development. This position performs analysis related to proper network, pricing design and system requirements necessary for accurate claims processing, which includes maintenance of documents, process improvements, feasibility testing and quality audit.
Responsibilities
Represent Network Operations and participate in large scale client facing projects, internal cross functional projects, and implementation interactions by providing insight, recommendations, and requirement gathering for Network Operations related items
Review and execute escalated, new, revised, and non-standard network operations requests; determine RxClaim system set up to ensure claims sequencing is accurate based upon analysis and interpretation for Commercial, Medicare Part D, and Specialty Pharmacy programs
Represent Network Operations by effectively communicating procedures, quality controls and addressing other related inquires during internal and external audits
Guide multiple smaller but complex projects independently and/or assist Functional Business Consultant on complex projects. Projects will include large sets of data and analysis with tools such as Alteryx, AQT and SQL
Perform complex quality reviews of large sets of data and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance
Assist in the intake of new projects, business initiatives and process improvements; work directly with assigned business area and consult with various levels across organizations as needed.
Create and deliver informal training for project and process improvements for successful and timely completion of work.
Perform user acceptance testing at a feature level and present new features to users in individual or group settings
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
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Bachelor's degree in IT, Business, Mathematics or related area of study, or equivalent combination of education and relevant work experience; HS diploma or GED required
2 years of work experience in network operations, pharmacy benefit management operations or and/or healthcare operations inclusive of experience manipulating large, complex data sets.
Strong communication and collaboration skills
Querying skills
Additional Qualifications
Effectively analyze information to resolve complex issues
Experience working on client facing initiatives, projects, and issue resolution
Organizational skills with ability to work on multiple projects simultaneously under strict timelines
Ability to drive results with strong commitment toward continuous process improvement and customer service.
Proficient in Microsoft Word and Excel.
Knowledge of AS400 system, query tools and advanced Excel functions
2 years of work experience in pharmacy benefit design, claims processing, or Pharmacy Benefit Management (PBM)
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.