Responsible for reviewing, auditing, and analyzing plan benefit coverage based on client’s intent.
Validate plan benefits coding accuracy using various tools
Perform requests from clients including claim analysis, running reports, etc.
Identify defects and report via client portal system
Create test scenarios and perform manual testing of claims
Attend calls and meetings as needed
Assist in creating reports and status to deliver to client
Support ad hoc requests
Responsible for meeting aggressive deadlines
Required
2-3 year of experience in data analysis and reporting
1-2 year of experience in performing data compares and data validation
1-2 year of experience in ticket/defect triage and documentation
2-3 year of experience in using Microsoft Office, Word, Excel
Strong analytical skills with great attention to detail
Outstanding verbal and written communication skills
Ability to adapt to changes and have flexibility with schedule
Desired
Knowledge in healthcare with general understanding of plan benefit desired
Pharmacy or prescription benefit experience preferred
PBM RxClaim Adjudication application navigation, claim submission, and triaging claims
GalaxE is a professional IT services firm that specializes in platform-driven solutions and the use of automation to achieve enterprise business transformation and mission-critical change for some of the largest companies in the world. Using our proprietary solution set, GxFource®, we apply machine learning techniques and predictive analytics tools as part of a broad artificial intelligence strategy that provides effective impact and data-driven business transformation.
Since its founding, GalaxE has been dedicated to advancing the benefits of technology. As we continue that legacy and look to the future, a focus on business enablement through agile, cost-efficient, and effective integration of people, process, and technology anchors our success. We revolutionize change in the costs of doing business that transform companies and their ability to leap beyond the competition.
At GalaxE we value people and are committed to diversity and inclusion where our employees are made to feel comfortable and are encouraged to be authentic. We focus on cultivating both traditional IT and non-traditional, new collar, workers through our Outsource to America®, program.
We are always looking for passionate, entrepreneurial-minded innovators and disrupters; game-changers that take ownership of the work they produce and bring it each and every day. Working with like-minded team members you will get a chance to discover, develop, and use cutting-edge technologies to transform the way we deliver creative business solutions.
Sound like you? Join us and find out for yourself what it means for you, and your career, to be part of the GalaxE team. Let’s build something, together. #WeAreGalaxE
Equal Opportunity Employer/Veterans/Disabled
Pay is based on several factors including market location and may vary depending on actual job-related knowledge, skills, and experience.
Physical Requirements
Prolonged periods of remaining stationary at a desk and working on a computer
Must be able to lift to 15 lbs., as needed
Must be able to work on-site (corporate/client offices), as needed (not applicable for 100% remote roles)
Occasionally required to bend, kneel, crouch, and reach overhead.
Hand-eye coordination necessary to operate computers and various pieces of office equipment.
Specific vision abilities required include close vision, the ability to tolerate fluorescent lighting, and the ability to adjust focus.
Employees must be able to perform the physical requirements of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees requiring accommodations to perform the essential functions of their jobs, absent undue hardship.
For more information, please visit https//www.galaxe.com/
Seniority level
Entry level
Employment type
Full-time
Job function
Business Development and Sales
Industries
IT Services and IT Consulting
Referrals increase your chances of interviewing at GalaxE.Solutions by 2x