Claims Configuration Jobs in Utah (NOW HIRING)

Who we are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting-edge technology, innovative cost-saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our Company values of:

• Integrity: Do the right thing. Especially when it's hard.
• Courage: Embrace the challenge.
• Together: Build bridges and lift up your colleagues

Job Summary:

As a Senior Benefits Configuration Tester, you have a substantial understanding of benefit design and apply your skills to complete a wide range of complex testing tasks. You will be responsible for submitting advanced test cases to validate the accuracy of benefit configuration setups, ensuring requirements are met for implementations and maintenance changes. Moving beyond routine execution, you will support junior team members, troubleshoot moderately difficult discrepancies, and serve as a vital liaison between the testing team and Benefit Operations seniors.

What will you do:

• Organize testing suites, create test plans, and submit moderately difficult test cases to validate the accuracy of complex benefit configuration setups.
• Serve as a key liaison with senior members of the Benefit Operations team, actively communicating to resolve configuration discrepancies, clarify plan designs, and report actionable insights back to the testing team.
• Provide support, guidance, and peer review for junior team members to ensure testing accuracy, helping them understand SmithRx claims adjudication systems and upstream/downstream processes.
• Handle Advanced Logic Validation such as Clinical/Prior Authorization and Financial Accumulators. Ensuring patient out-of-pocket maximums and cost-shares remain accurate.
• Document detailed defect reports for issues uncovered during testing and assist in the development of process improvements focusing on efficiency and accuracy.

What will you bring to SmithRx:

• Minimum of 2 - 4 years of related experience in benefits configuration or testing in healthcare. PBM or managed care experience is preferred but not required.
• Associate degree or equivalent work experience is required.
• Strong understanding of benefit design standards, including HIPAA, NCPDP, and SmithRx internal business standards, alongside moderate skills in Microsoft Excel.
• Ability to work with little instruction on daily work, relying on general instructions only for newly introduced assignments.
• Strong critical thinking skills, such as analyzing data, drawing logical conclusions, and applying smart solutions to moderately difficult situations.
• Communicate effectively (written, verbal/presentation, and active listening) to successfully act as a liaison and collaborate cross-functionally.

What SmithRx Offers You:

• Highly competitive wellness benefits including Medical, Pharmacy, Dental and Vision Insurance. SmithRx pays up to 90% for you and your family.
• Fully paid Life insurance and Disability benefits
• 3 weeks PTO
• 401(k) Retirement Savings Program
• Flexible Spending Benefits
• Generous Paid Parental Leave benefits
• Professional development, training and career growth opportunities
• Well-stocked kitchen