RX Accumulator Specialist I

    • Job Tracking ID: 512935-600964
    • Job Location: Meridian, ID
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: December 08, 2017
    • Years of Experience: Up to 2 Years
    • Starting Date: January 8, 2018
    • Salary Type:: Hourly
    • Rate:: 12.14
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Job Description:

Job Summary

This team member will be responsible for all aspects that are included in the RX accumulator automation process, this will include reviewing adjudication systems reports for daily automation loads and identifying issues for resolution that would cause loads to fail. Perform weekly sample audits of each client on automation process. Perform complete audit of clients in the test environment before migrated to live production. Update member’s Medical and RX deductible and out-of-pocket dollars in the GBAS adjudication system. Perform sample audits of the accumulator loads to ensure continued accuracy.

Key Result Areas

  • Reconciliation of daily load reports

  • Manual updates of deductible and out-of-pocket dollars that fail the load process

  • Monthly audits at the client base to identify members where the deductible and/or out- of-pocket accumulators have been over-applied.

  • Maintain a three-day turn-around time for internal and external audit requests. Track requests and follow-up on outstanding requests.

  • Identify any areas of concerns or negative impact to the client and or organization.

  • Identify and resolve errors that are generated out on daily reports for the automated accumulators.

  • Answer questions from Customer Care, Client Service Coordinators (CSCs), and Account Managers.

  • Complete account audits to ensure data is accurately displayed in GBAS system (client and member level).

  • Generate and review reports for over-applied dollars, once identified send and track requests for adjustments.

  • Understand the impact inaccuracies have on our members, brokers and clients.

  • Perform other duties as assigned to assist team with maintaining expected turn-around time.

  • Bring forward ideas for process improvement.

Experience and Skills:

Minimum Qualifications

  • High school education or equivalent

  • Team and goal oriented

  • Good knowledge of Microsoft Office (Word, Excel, Outlook, etc.)
  • Good written and verbal communication skills
  • Good organizational skills
  • Industry knowledge of TPA products preferred
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines
  • Ability to maintain excellent working relationships with all departments
  • Demonstrate a strong attendance record with minimal unscheduled absences
  • Attention to detail

  • Self-motivated

  • Critical thinking skills

  • Excellent problem-solving skills

  • Must maintain good customer service relationships with internal and external customers

  • Completes all projects in a timely and accurate manner

  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group