Secure Eclaims

Specific job functions include:

· Review and understand PBM contracts for all relevant pricing terms

· Review and understand plan design documents provided by PBM or client

· Utilize company’s proprietary Compliance Model

· Calculate client contractual financial guarantees, admin fees, rebates and other terms as required by client contract

· Assemble audit reports and summarize findings

· Document all potential issues and track decisions

· Collaborate with account management and pharmacy consultants to discuss results with clients and vendors

· Provide documentation during follow-up negotiations and discussions

· Work with IT to further develop Compliance Model logic and capabilities

· Assist in other financial projects as needed

Requirements:

· Bachelor’s degree in Business, Finance, or other health related field

· At least 3 years of either a) pharmacy benefit audit or b) claim adjudication research experience on one or more PBM platforms

· Working knowledge of the PBM industry and pharmacy benefit claims

Desired Skills:

· Proficient in Microsoft Office, with extensive experience working with Excel

· Basic SQL query building

· Strong verbal and written communication skills

· Detail-oriented

· Solid, independent worker (this position will likely be based in the applicant’s home)

· Pharmacy Technician Certification (preferred)