Job description
Overview:
Our Locations
E xperience:
Knowledge, Skills, and Abilities:
WE OFFER: A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:
Maxor is an EOE, including disability/vets
Maxor has an opportunity for an experienced
Sr. Adjudiction Analyst to join our growing pharmacy company. Under minimal supervision, the Sr. Adjudication Analyst will perform systems and applications analysis/design/build and/or testing to deliver timely and accurate set up of benefits according to service levels to our clients.
Our Company
We're Maxor and we're building a different kind of pharmacy company. We're transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies. We put people first and are committed to providing outstanding service across all aspects of our business. We believe there's a better way to deliver pharmacy and healthcare services to people across the country, and we'd love for you to help us do it.
Our Locations
The Maxor workforce brings robust experience, diverse perspectives and passion from over 1,000 employees working all over the US in pharmacies, hospitals, home offices, or corporate offices. This is a remote, home-based role.
Responsibilities:
- Setup or QA system configurations coordinating with account teams, implementation, clinical or programming staff, as necessary. Implement and maintain programs and products for existing and new clients.
- Maintain technical standards for plan structure, tracking and audit compliance.
- Provide continual evaluation of processes and procedures.
- Provide suggestions or methods to improve operational efficiency or delivery of services to our clients within supported systems.
- Be available as a subject matter expert for complex build and adjudication analysis.
- Act as a role model, portray a team attitude, and encourage other inner-department staff to reflect the same attitude.
- Serve as functional liaison between programming staff and other departments.
- Participate in the Quality Assurance Program.
- Maintain comprehensive knowledge of the MaxorPlus system, including the ability to set up all plan types.
- Train/mentor administrators in plan set-up and implementation as a means to effectively manage the adjudication system.
- Work cooperatively with other staff members to enhance the team concept while recommending and coordinating changes to operational processes and guidelines.
- Perform other duties as assigned based on business needs.
- Promptly report any allegations of impropriety to the Compliance Department.
- Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance
- Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
- Complete required training, as assigned, within the established timeframes.
Education:
- BA/BS degree preferred or equivalent combination of education/experience and skills required.
E xperience:
- At least 24 months proven analytical, communication and organizational skills.
- Experience building, testing, analyzing benefit set up and paid claims on Pharmacy Benefit Management Systems, or similar functions.Must have technical experience with structuring and maintaining data across an adjudication platform.
- Prior pharmacy benefits management, health care, or managed care experience required.
Knowledge, Skills, and Abilities:
- Advanced knowledge of PCs, including Windows, MS Office (Outlook, Word, emphasis on Excel).
- Excellent analytical skills
- Excellent decision-making/prioritization skills
- Excellent verbal and written communication skills
- Ability to work on complex projects with people in diverse disciplines
- Ability to comprehend detailed specifications
- Ability to multi-task
- Ability to analyze system limitations and suggest improvements
- Working knowledge of NCPDP standards
- Excellent knowledge of client service relative to technical PBM applications.
- Microsoft Access experience a plus. Excellent knowledge of the Maxorplus systems a plus.
WHY MAXOR?
Did you know that patients see their pharmacist an average of 12 times a year? Pharmacy is at the heart of healthcare. Come join Maxor and make a direct impact on patients’ lives. Improve your own wellbeing with our robust benefits and flexible work environment. At Maxor, you have a career with limitless possibilities and the charge to make a difference. A company of 1,000 diverse people and almost 100 years of pharmacy experience, we offer the stability of a Fortune 500 company with the energy and innovation of a startup. We provide services and technology that fuel the entire pharmacy ecosystem, but we are more than pharmacy services. We enable pharmacy
care.
WE OFFER: A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
- Company paid basic life/AD&D, Short-term and Long-term disability insurance
- Rx, dental, vision, short-term disability, and FSA
- Employer-matched 401k Plan
- Industry leading PTO plan
- And MORE!
Maxor is an EOE, including disability/vets
Please apply online at: https://careers-maxor.icims.com/
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