Pharmacy Benefit Analyst Full Time NEW

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

As a Pharmacy Benefit Analyst, you’ll serve as the technical subject matter expert supporting the Pharmacy and Product Configuration teams on Pharmacy Benefit Manager (PBM) benefit coding and programs. You will research and analyze benefit configuration needs, troubleshoot process and system issues, and partner with internal teams and external vendors to ensure accurate PBM set-up. In this role, you’ll validate claim adjudication and plan configuration through quality assurance and testing, provide oversight of PBM data interfaces, and assess configuration changes for compliance with applicable state and federal regulations. You’ll also respond to inquiries, recommend standard and custom configuration options, and identify and escalate potential risks impacting benefit configuration. This is a high‑impact individual contributor role where you’ll work in a small, highly visible team, with your work directly affecting how pharmacy benefits function for members and providers.

What you’ll do:

• Provide technical support and partners with PBM vendor (Express Scripts), Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding, interpretation of pharmacy benefits and new pharmacy product builds.
• Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been completed appropriately and reviews system generated outputs to validate outcomes.
• Provide oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct.
• Research and provide direction to team on complex PBM benefit coding and compliance issues. Provide input to PBM vendor, IT and teams on custom benefit requests and make recommendations for alternative approaches. Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing.
• Collaborate with cross functional Premera teams (sales, system configuration, claims, contract services, group set-up, membership and billing, customer service), on feasibility and processing requirements for new and custom products and services, to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues.
• Create, maintain and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work and mitigate any risks. Develop processes and procedures for new and changing requirements.
• Develop training content and provide instruction to staff both 1:1 and in classroom setting. Work collaboratively with training staff in developing training programs.
• Monitor delivery and tracking for wide range of inquiries, activities and workload within team providing direction to team members and on-going status reports to leadership.
• Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.

What you’ll bring:

• Bachelor’s degree or four years equivalent experience (Required).
• Washington Pharmacy technician License (Preferred).
• 3 years PBM technical experience in benefit coding or claims adjudication or related area which includes at least one year experience in PBM benefit configuration or equivalent (Required).
• In-depth knowledge of pharmacy benefit coding (Preferred).
• Previous experience in Premera product configuration (Preferred).
• Previous experience troubleshooting production issues within claims or customer information systems or databases (Preferred).
• Medicare Part D Benefit Experience (Preferred).
• Demonstrated ability to independently analyze pharmacy product designs and develop an alternative configuration approach to achieve desired outcome (Preferred).
• Experience in proactively applying analytical, problem solving and / or technical abilities to daily responsibilities.
• Ability to learn and effectively understand/utilize new concepts and functions quickly.
• Strong written and verbal communication skills, and ability to establish and maintain effective relationships.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they’re a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$80,200.00 – $114,200.00

National Plus Salary Range:

$80,200.00 – $130,200.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.