Pharmacy Analyst

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We’ve stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Position: Pharmacy Analyst

Location: Philadelphia PA

Duration: 4 months

Job Description: 

The primary purpose of the job is to:

• To maintain, review, and provide consultation on basic to moderately complex customer benefits. The benefit claims analyst also analyses claims reports to identify trends, issues, and present recommendations.

• Maintains current knowledge of Medicare requirements related to Part D Chapters 5, 6, and 14 as they pertain to benefits and claims adjudication

• Researches benefit and claims related inquiries

• Makes recommendations for fulfilment of basic to moderately complex benefit requests

• Documents benefit design specifications for submission to the claims processing vendor

• Prepares test plans, scenarios, and executes testing

• Monitors and reports claims activity based upon benefit set-up to ensure accurate processing according to the approved requirements from the customer

• Troubleshoots reported claims defects and provides detailed summary of analysis and all available solutions for immediate mitigation

• Processes claims transaction requests (rework)

• Makes recommendations to management based upon trend analysis

• Reviews and writes comprehensive reports, identifies alternatives, and makes recommendations to management.

• Participation including leading of audits related to benefit or claims activity

• Performs other related duties and projects as assigned by the department Director or Regional Supervisor.

• Supports and carries out the PerformRx Mission & Values.

• Maintains a current knowledge base of PerformRx programs, services, policy and procedures.

• Regularly reviews and adheres to standard operating guidelines, desktop procedures, checklists, templates, and memorandums issued to the department.

• Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.

• Establishes and maintains positive communication and professional demeanor with PerformRx employees and customers at all times.

• Demonstrates and supports commitment to corporate goals and objectives

Bachelor s Degree:

• 3 to 5 years PBM, pharmacy operations, or claims processing experience required

• Progressive and focused work experience in continuous improvement initiatives, project management, and/or organizational development.

• CPhT certification preferred

Kind Regards

Sachin Gaikwad

Technical Recruiter

Direct Line : 732-429-1920 

Board: 732-549-2030 - Ext 301

Website: www.irionline.com 

Integrated Resources, Inc