Alliance/Partner Management, Business Processes, Calendar Management, Channel Strategies, Consulting, Cross-Functional, Customer Relationship Management (CRM), Data Analysis, File Maintenance, File Management, Identify Issues, Insurance Claims, Pharmacy, Problem Solving Skills, Regulations, Supplier Relationship Management (SRM), Team Player, Test Plan/Schedule, Testing, Training Program, Use Cases, Vendor/Supplier Relations, Vendor/Supplier Selection
East Syracuse, NY, New York
Scope of Responsibilities: The PBM Vendor Partner Analyst is a member of the ProAct Partner Services reporting to the Director of Partner Services This role will be responsible for integration, configuration, testing, and management of ongoing vendor partner relationships.
Job Summary: PBM Vendor Partner Analyst acts as ProAct’s SME on all aspects of vendor partner integrations involving claim systems, data exchanges with TPA's and vendor partners, file feed layouts and accumulator file management. This position will partner with key internal/external technical and business teams and lead new vendor partner integrations. This role will manage ongoing vendor partner relationships.
Responsibilities:
- Responsible for working with new and existing partners in the development and administration of ProAct’s core business processes related to accumulators, which includes working with a variety of TPA’s (Third Party Administrators), electronic transmissions of various file types, and reporting needs
- Responsible for ongoing vendor partner relationships
- Work with cross functional teams to systematically integrate and support new partners into standard accumulator business processes (for pharmacy and medical)
- Work with TPA and clients to define/maintain/troubleshoot file feeds and layouts based on specific application.
- Partner with development to test custom programming related to processing and automating accumulator data
- Consult with internal teams on the end-to-end file transfer process, including planning, scheduling, and execution.
- Collaborate with internal teams to understand file transfer requirements and implement appropriate solutions.
- Troubleshoot and analyze data issues within raw data feeds and reports
- Test file exchange
- Explain requirements and processes to internal/external technical and business partners in a variety of ways (use cases, logical diagrams, flow charts)
- Creation and maintenance of TPA profiles within the CRM
- Ensure NDA/BAA are in place prior to establishing a new data sharing arrangement with a vendor partner
- Responsible for completing all mandatory and regulatory training programs
- Perform other duties as assigned
Qualifications:
Education:
- Bachelor’s degree preferred. Relevant experience considered for exceptional candidates.
Experience:
- Pharmacy Technician or related experience highly desirable
- 1-3 years of PBM experience in claims or insurance operations