Senior Benefits Administration Analyst

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🕒 5 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $75.000 - $113.000 / ano

⏰ Tempo Integral

🟠 Sênior

🖥️ Administração

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RxSense

SiteLinkedInTodas as Vagas

201 - 500 funcionários

⚕️ Seguro de Saúde

💊 Farmacêutico

☁️ SaaS

💰 Private Equity Round em 2020-05

Healthcare Insurance • Pharmaceuticals • SaaS

A RxSense é uma empresa HealthTech dedicada à modernização do gerenciamento de benefícios farmacêuticos. Eles desenvolvem produtos de ponta que otimizam a adjudicação e análise de sinistros, visando reduzir custos e melhorar o acesso dentro do ecossistema farmacêutico. A RxSense oferece soluções para PBMs, farmácias, fabricantes de produtos farmacêuticos, pagadores e consumidores, apoiando melhores resultados para milhões de pessoas diariamente. Seus produtos incluem ferramentas avançadas como o motor de adjudicação RxIQ Enterprise, uma plataforma de análise de inteligência de negócios e otimização de preços baseada em IA. Eles são conhecidos pela sua marca principal de economia em prescrições, SingleCare, que ajuda os consumidores a garantir preços acessíveis, beneficiando parceiros farmacêuticos.

Descrição

• Own and lead the full implementation lifecycle for large, complex, or strategic clients from initiation through production deployment, ensuring all contractual deliverables are met on time and within scope. • Serve as the primary benefits configuration expert on client implementations, leading all discovery, requirements gathering, and configuration sessions. • Anticipate and proactively mitigate implementation risks; develop contingency plans and communicate issues to leadership with recommended solutions. • Review and validate benefit set-ups performed by junior analysts prior to client go-live. • Configure and maintain complex benefit designs, clinical rules, pharmacy networks, pricing structures, accumulators, and hierarchies across the RxSense platform. • Develop deep expertise in RxSense claims platforms and serve as an internal resource for platform capabilities and limitations. • Lead root-cause analysis on complex benefit set-up issues; develop and implement process changes to prevent recurrence. • Conduct impact analysis for platform changes, client requests, and identified issues affecting benefit configurations. • Build and sustain trusted advisor relationships with clients, serving as a consultative partner on benefit design strategy and platform optimization. • Represent Benefits Administration in cross-functional meetings, client steering committees, and escalation calls. • Partner with Client Services, Pharmacy Networks, UAT/QA, IT, Finance, and Clinical teams to drive flawless implementations and ongoing client satisfaction. • Provide mentorship, training, and day-to-day guidance to Benefits Administration Analysts and other team members. • Develop and deliver training materials for internal staff and private-label clients on benefit set-up requirements and platform best practices. • Act as an escalation point for the team on complex or ambiguous benefit configuration challenges. • Identify and lead initiatives to improve departmental workflows, documentation, and quality standards. • Assist the Director in developing and maintaining department policies, procedures, and best practices. • Contribute to strategic projects and product initiatives as a subject matter expert.

🎯 Requisitos

• Bachelor's degree or equivalent experience in healthcare, pharmacy benefit management (PBM), or a related field • 5+ years of experience in pharmacy benefit management, client implementations, or plan builds, with at least 2 years in a senior or lead capacity • Experience with PBM claims processing platforms required; RxSense platform experience strongly preferred • Prior experience in a consultative client-facing role strongly preferred

🏖️ Benefícios

• RxSense believes in a diverse workforce • Equal Opportunity and Affirmative Action employer