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Medicare Part D Claims Analyst

This position is responsible for overseeing the accurate adjudication and administration of Part D claims and formulary administration.

Essential Functions

  • Test the accuracy of the formulary administration policy, including transition, by reviewing daily transition monitoring reports, conducting routine audits on formulary rejections and performing trend analysis.
  • Make outreach to members and pharmacies to resolve claims that reject inappropriately.
  • Facilitate review of the processes that support retro-active enrollment changes, changes in LICs status, and member notifications
  • Report trends in claims rejections and potential areas of non-compliance to Compliance officer.
  • Ability to identify member impact by issue.
  • Initiate client communications related to trended issues.
  • Assist in investigating and correcting operational issues that result in denied claims.
  • Develops, implements, and maintains an audit tracking and documentation system.

Qualifications

  • Intermediate level of proficiency in MS Excel (writing formulas, filtering and working with large data sets)
  • 2+ years of data and complex ad hoc analysis experience
  • Deep Medicare part D claims experience

Education

  • Pharmacy Tech License preferred

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Medicare Part D Claims Analyst

Thank you for your interest in the Medicare Part D Claims Analyst position. Please provide the information below and we will contact you to schedule a call if interested. This link will remain active until the position has been filled.
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