Description:

Prime is looking for a functional business consultant to bridge the gap between the operational areas of the business and RxClaims. These are basically SME's of Claims, Benefits, Eligibility, Accums, and Prior authorization to RxClaims team. They are essential to workstream leads that work on new client implementations or system enhancement projects as it relates to RxClaims and ops.

Skills:

Strategic planning, Business strategy, Data accuracy, Project development, RxClaims, Claims, benefits, PBM operations, Pharmacy, Eligibility, Intake, Prior Authorization, Strategy

Top Skills Details:

Strategic planning,Business strategy,Data accuracy,Project development,RxClaims,Claims,benefits,PBM operations,Pharmacy,Eligibility,Intake,Prior Authorization

Additional Skills & Qualifications:

Day to day responsibilities:

• Work directly with business and users to support and improve existing applications and processes related to assigned business system.

• With direction from a Functional Business Consultant, researches and resolves business and technical problems by identifying, evaluating, and implementing improvements to processes and applications.

• Represents assigned business system or business process as a subject matter expert in the development of business requirements, system specifications, process flows, process change and/or project management.

• Perform root cause analysis, monitor system defects for timely resolution, and complete research to determine financial impact to clients when system issues are discovered.

• Advise clients on the implementation of new business processes and systems.

• Monitor progress of projects to ensure objectives were achieved within established timelines.

• Identified areas of improvement within the organization and provided guidance on strategic initiatives.

Must have:

Bachelor's or equivalent work experience

5 years of business consultant experience

5 years of RxClaims experience

Must have knowledge of how RxClaims works in relation to operational areas vs IT areas.

Next would be someone working at another PBM with extensive knowledge with RxClaims and business partnerships.

Experience Level:

Expert Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.