Our client, a IT Services and Consulting company, is looking for a RxClaim / PBM Claims SME – Pharmacy Benefits (MedD / Adjudication Expert) for their Eden Prairie, MN/ Hybrid location. Requirements:

+ In depth knowledge on RxClaim Adjudication, claims processing, MedD claims

+ Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR)

+ Knowledge on business & plan configuration and plan option knowledge.

+ Facilitate discussion with Product Owners, Business and clarify business requirements

+ High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.

+ Years of Experience: 10.00 Years of Experience

Skills:

+ Category Name Required Importance Experience

+ Healthcare Benefit Administration-PBM Yes 1 ...