Express Scripts Claims Analyst, Medical Benefits Management in Whitestown, Indiana

POSITION SUMMARY

Serve as lead tactical support and subject matter experts to the Account Management, Client Benefit Administration, and Client Service Center to assist with efficient resolution of Customer and Client related and single member issues due to Eligibility and CBA indemnity set up issues. Handle complex inquiries from clients related to retail and paper claim benefits. Work to research and resolve indemnity problems in a timely manner. Interacting directly with Account Management, Patient Advocates, Retail pharmacies, Claims Management and various points of escalation within the company to resolve issues. Document issues and resolution in several common databases. Help to identify repetitive problems or questions in order to pursue process or procedural changes. Escalate, prioritizes, and delegates issues as necessary.

ESSENTIAL FUNCTIONS

  • Serve as point of contact for the claims Team to delegate, prepare, and prioritize escalated indemnity issues for the Account Management, Client Benefit Administration, and Client Service Center.
  • Responsible for claims team professional and timely responses to all inquiries.
  • To attend strategic meetings regarding corrections to projects to correct benefit and eligibility issues.
  • Make independent judgments in order to respond to complex or critical customer claim related issues requiring a higher degree of expertise or discretion to resolve customer or client issues and ensure timely resolution.
  • Involve Account Manager or Leadership team in heightened client/member issues.
  • Analyze research and resolve requests for expedited or escalated claim issues including member submitted, pharmacy submitted, or indemnity issues.
  • Manipulate any of the five separate applications in order to research and resolve claim issues.
  • Maintain accurate and complete documentation.
  • Update all logs and Call Center tools with claim status.
  • Maintain service levels and performance guarantees.
  • Identify, document and report all repetitive questions and/or problems as well as adjudication errors to identify trends and recommend potential solutions.
  • Special Projects as assigned.

QUALIFICATIONS

  • High school diploma or equivalent required.
  • Some college or technical training preferred.
  • 3-5 years’ experience in PBM industry or ESI claims department or equivalent work experience.
  • Strong data entry, 10-key skills, general PC skills and MS Office experience.
  • Management or team leadership experience, desired.
  • Strong knowledge of ESI Policy & Procedures.
  • Strong attention to detail and good retention skills.
  • Self-motivated and ability to effectively prioritize multi tasks and deadlines.
  • Highly developed written and oral communication skills.
  • Ability to work in fast-paced, production environment.
  • Analytical mind and the desire to follow a project through to completion.
  • Retail pharmacy, customer service experience helpful but not required.

ABOUT THE DEPARTMENT

The Pharmacy Operations Group is crucial to achieving our mission of practicing pharmacy smarter and putting medicine within reach. Members of this team are at the front line every day interacting with patients, strategizing on improvements and efficiencies, and processing the more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.