Sr. Adjudication Analyst (Benefits)

<strong><i>"Outstanding people are the key to our success."</i><BR>Mike Ellis, CEO, Maxor National Pharmacy Services, LLC<BR><BR>Committed to the cost-effective delivery of impactful pharmacy and healthcare services to patients and clients, Maxor is an employee-driven organization where excellence is valued, recognized and rewarded. Talented and dedicated professionals like you continue to distinguish us as a national pharmacy and healthcare service provider like no other in the industry.</strong>

Remote, TX

Maxor National Pharmacy Services Company

<p>At Maxor, we&rsquo;re transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies.</p> <p>We put People First and are committed to providing outstanding service across all aspects of our business. Our goal is to create Flexible and Innovative solutions filled with inspired possibilities.<br /><br />The innovative spirit at Maxor will transform the way you think about pharmacy &amp; healthcare services. As we pave the way in a relentless commitment to positive health outcomes, it&rsquo;s never been a better time to be part of the Maxor team!<br /><br /><strong>Maxor is an EEO/AA/M/F/Vets/Disability</strong></p> https://careers-maxor.icims.com/jobs/intro?hashed=-435589753

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Full Time

Overview: <strong>Position:<br /><br /></strong>The Sr. Adjudication Analyst (Benefits) will perform systems and applications analysis/design/build and/or testing to deliver timely and accurate set up of benefits according to service levels to our clients. <br /><br /><strong>Our Company:</strong><br /><br />MaxorPlus is transforming Pharmacy Benefit Management to create healthier member lives through purposeful engagement. Integrating analytics, technology and information to identify intervention opportunities to communicate and engage with members to create change. Our proprietary engagement platform, combined with our suite of clinical solutions, guides members to make better, more informed choices, resulting in cost savings and improved clinical results. Grounded in our philosophy to put people first through our commitment to outstanding service, this foundation creates a PBM solution that is flexible, innovative and filled with inspired possibilities. MaxorPlus Inspiring What's Next. <br /><br /><strong>Locations:</strong><br /><br />The Maxor team brings robust experience, diverse perspectives and passion from a nationwide team of 900+ professionals located in more than half of the US states.
Responsibilities: <ul> <li>Setup or QA benefits, coordinating with account teams, implementation, clinical or programming staff, as necessary.</li> <li>Implement and maintain programs and products for existing and new clients.</li> <li>Maintain technical standards for benefit plan structure, tracking and audit compliance.</li> <li>Provide continual evaluation of processes and procedures.</li> <li>Provide suggestions or methods to improve operational efficiency or delivery of services to our clients within supported systems.</li> <li>Be available as a subject matter expert for complex build and adjudication analysis.</li> <li>Act as a role model, portray a team attitude, and encourage other inner-department staff to reflect the same attitude.</li> <li>Serve as functional liaison between programming staff and other departments.</li> <li>Participate in the Quality Assurance Program.</li> <li>Maintain comprehensive knowledge of the MaxorPlus system, including the ability to set up all plan types.</li> <li>Train/mentor benefit administrators in plan set-up and implementation as a means to effectively manage the adjudication system.</li> <li>Work cooperatively with other staff members to enhance the team concept while recommending and coordinating changes to operational processes and guidelines.</li> <li>Perform other duties as assigned based on business needs.</li> <li>Promptly report any allegations of impropriety to the Compliance Department.</li> <li>Comply with Maxor&rsquo;s Ethical Business Conduct policy and Maxor&rsquo;s Compliance</li> <li>Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.</li> <li>Complete required training, as assigned, within the established timeframes.</li> <li>Must be able to cope with the mental and emotional stress of the position.</li> <li>Maintain regular attendance in accordance with established policies.</li> <li>Perform other job-related duties as assigned.</li> </ul>
Requirements: Education:<br /><br /> <ul> <li>BA/BS degree preferred or equivalent combination of education/experience and skills required.</li> </ul> <br />Experience:<br /><br /> <ul> <li>At least 24 months proven analytical, communication and organizational skills.</li> <li>Experience building, testing, analyzing benefit set up and paid claims on Pharmacy Benefit Management Systems, or similar functions.</li> <li>Must have technical experience with structuring and maintaining data across an adjudication platform.</li> <li>Prior pharmacy benefits management, health care, or managed care experience required.</li> <li>Advanced knowledge of PCs, including Windows, MS Office (Outlook, Word, emphasis on Excel).</li> <li>Excellent analytical skills</li> <li>Excellent decision-making/prioritization skills</li> <li>Excellent verbal and written communication skills</li> <li>Ability to work on complex projects with people in diverse disciplines</li> <li>Ability to comprehend detailed specifications</li> <li>Ability to multi-task</li> <li>Ability to analyze system limitations and suggest improvements</li> <li>Working knowledge of NCPDP standards</li> <li>Excellent knowledge of client service relative to technical PBM applications.</li> <li>Microsoft Access experience a plus. Excellent knowledge of the Maxorplus systems a plus.</li> </ul> <br /><strong>Why Maxor?</strong><br /><br />Maxor offers a progressive culture that supports a work from home model, a &ldquo;dress for your day&rdquo; attire, and a collaborative, team oriented environment. We offer a comprehensive compensation &amp; benefits package including:<br /><br /> <ul> <li>$750 individual, annual medical deductible, $25 office visit copays, Low biweekly premiums</li> <li>Company paid basic life/AD&amp;D, Short-term and Long-term disability insurance</li> <li>Rx, dental, vision, short-term disability, and FSA</li> <li>Employer-matched 401k Plan</li> <li>Industry leading PTO plan</li> <li>And MORE!</li> </ul> <br />Maxor is an EEO/AA/M/F/Vets/Disability<br /><br />Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities<br /><br /> Please apply online at: https://careers-maxor.icims.com/<br /><br />Maxor is an EEO/AA/M/F/Vets/Disability