Sav-Rx, located in Fremont, NE, is dedicated to improving the health and lives of our patients through exceptional clinical practices and unwavering commitment to best-in-class service delivery. The Sav-Rx experience is defined by superior service, competitive rates, transparent practices, and cutting-edge clinical programs delivered by outstanding, professional associates.

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.

Job Description

Operations Specialist Role and Responsibility

· Responsible for gathering data for specialized reporting for clients including RDS, CAA, and Litigation.

· Responsible for gathering business requirements, extract and prepare the data for ad-hoc reports requested by clients.

· Perform in depth analysis of claims data for regular audits for commercial and Qualified Health Plans.

· Provide departmental support for testing and QA for both new plan setups and plan changes to validate claim accuracy against the client benefit, clinical, network and pricing parameters.

· Assist with benefit configuration, including new plan set-up and plan change set-up.

· Assist with all aspects of network pharmacy configuration, including set-up, rate changes and chain code updates.

· Make recommendations to streamline the work processes and systems that impact departmental work flow to create efficiency and quality outcomes

· Develops standard procedures, training materials and provide training for internal department processes.

· Maintain acceptable and appropriate quality levels and production SLA response time

· Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquires submitted by our internal business partners

· Partner with client account team as clients go live and troubleshoot benefit-related discrepancies, errors, and problems

· Collaborate with customer success teams and Account Management to review and resolve inquires related to benefits to improve member experience.

· Provide troubleshooting support for our claims adjudication process.

· Work with clinical teams to update formularies with changes at their direction.

· Other duties as assigned due to business needs.

Qualifications and Education Requirements

· Associate’s or Bachelor’s degree preferred in Business. Computer Science or related field.

· 2+ years of experience directly related experience querying/summarizing data in a benefit environment.

· Intermediate to advanced skills with Microsoft Office.

· SQL and data analytics experience (preferred)

· Strong analytical skills with the ability to collect, organize and disseminate significant amounts of information.

· Strong organizational skills, research skills, time management, project management, and critical thinking skills

· Exceptional verbal and written communication skills.

· Demonstrated initiative in solving problems, process improvement across departments, tremendous attention to detail, ability to deliver and receive effective feedback.

· Highly dependable, ability to shift priorities easily and ability to work in high paced, deadline driven environment

Our comprehensive benefits package includes:

Two Medical Plan Options, Prescription Coverage, as well as Voluntary Term Life, Dental, Vision, Critical Illness, Accident coverage. Funeral Leave, Six Paid Holidays, Paid Time Off, 401K eligibility after 1 year.

(Benefits effective the first of the month following 60 days of employment)

Job Type: Full-time

Pay: $45,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Bonus pay

Experience:

• Data analytics: 2 years (Preferred)
• Claims Adjudication Programming: 2 years (Preferred)

Work Location: One location

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