Pharmacy Analyst - Provider Services & Claims Administration
On-siteAlberta, Canada
Job Summary
Process manual pharmacy claims, including high-cost drug claims, ensuring accurate adjudication in accordance with drug benefit plan coverage. Perform quality assurance checks on claim results, complete necessary claim adjustments, and assist pharmacy providers with submissions, reversals, and collections. Research and analyze information to resolve complex inquiries, conduct system testing, and track reporting on work initiatives. Monitor individual production to meet output quantities and timelines while making suggestions to improve workflows and increase efficiency. Occasionally work flexible hours to support the team. This role supports the Provider Services & Claims Administration team within a not-for-profit organization serving over 1.8 million members.
Required Qualifications
- Demonstrated commitment in delivering superior customer service
- Strong problem-solving abilities
- Attention to detail
- Excellent organizational and time management skills
- Ability to prioritize tasks, manage a heavy workload, and meet tight timelines
- Ability to adapt to changing priorities and processes
- Ability to work with minimal supervision
- Strong sense of accountability
- Computer proficiency with Microsoft Word
- Computer proficiency with Microsoft Excel
- Computer proficiency with Microsoft Outlook
- Criminal record check satisfactory to Alberta Blue Cross
Desired Qualifications
- Exposure to Access
- Knowledge of the pharmacy industry, including drug plan design and claim adjudication standards
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