Senior Benefits Administration Analyst

Job not on LinkedIn

🔥 8 hours ago

🇺🇸 United States – Remote

💵 $75k - $113k / year

⏰ Full Time

🟠 Senior

🖥️ Administration

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RxSense

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

💰 Private Equity Round on 2020-05

Healthcare Insurance • Pharmaceuticals • SaaS

RxSense is a HealthTech company dedicated to modernizing pharmacy benefit management. They develop cutting-edge products that optimize claims adjudication and analysis, aiming to lower costs and improve access within the pharmacy ecosystem. RxSense offers solutions for PBMs, pharmacies, pharma manufacturers, payers, and consumers, supporting better outcomes for millions of people daily. Their products include advanced tools like the RxIQ Enterprise adjudication engine, business intelligence analytics platform, and AI-based pricing optimization. They are known for their flagship prescription savings brand, SingleCare, which helps consumers secure affordable prices while benefiting pharmacy partners.

📋 Description

• 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.

🎯 Requirements

• 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

🏖️ Benefits

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