RX Accumulator Specialist I

    • Job Tracking ID: 512935-735501
    • 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: June 25, 2020
    • Years of Experience: Up to 2 Years
    • Starting Date: July 27, 2020
    • Salary Type:: Hourly
    • Rate:: $12.75
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Job Description:

The RX Accumulator Specialist I is 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. Performs weekly sample audits of each client on automation process. Performs complete audit of clients in the test environment before migrated to live production. Updates member’s medical and RX deductible and out-of-pocket dollars in the GBAS adjudication system. Performs sample audits of the accumulator loads to ensure continued accuracy.

Key Result Areas

  • Reconciles daily load reports.
  • Updates manually deductible and out-of-pocket dollars that fail the load process.
  • Performs monthly audits at the client base to identify members where the deductible and/or out- of-pocket accumulators have been over-applied.
  • Maintains a three-day TAT (Turnaround Time) for internal and external audit requests.
  • Tracks requests and follows-up on outstanding requests.
  • Identifies any areas of concerns or negative impact to the client and or organization.
  • Identifies and resolves errors generated out on daily reports for the automated accumulators.
  • Answers questions from Customer Care, Client Service Coordinators (CSCs), and Account Managers.
  • Completes account audits to ensure data is accurately displayed in GBAS system (client and member level).
  • Generates and reviews reports for over-applied dollars, once identified send and track requests for adjustments.
  • Understands the impact inaccuracies have on our members, brokers and clients.
  • Brings forward ideas for process improvement.
  • Performs other duties as assigned or needed.

Experience and Skills:

  • High school degree or equivalent.
  • Industry knowledge of TPA products preferred.
  • Team and goal oriented.
  • Ability to maintain excellent working relationships with all departments.
  • 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.
  • Types 45 wpm, 10-key and computer knowledge.
  • Able to demonstrate excellent attendance and punctuality with minimal unscheduled absences.
  • Excellent customer service attitude and professionalism.
  • Demonstrate Accuracy, Customer Service, Timely Turn-Around (ACT).
  • Exceptional verbal and written communication skills.
  • Proficiency using Microsoft Office (Word, Excel, Outlook, etc.).
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
  • Possess a high degree of integrity and discretion, as well as the ability to adhere to both company policies and best practices.
  • Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
  • Ability to efficiently and effectively perform the Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
  • Protect and enhance the Core Purpose and the Core Values of AmeriBen.

AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com.