Prescription Plan Design & Escalations Analyst 1-4

Job Description

Job Description

The Fountain Group is currently seeking a Healthcare Claims Analyst for a prominent client of ours. This is a remote opportunity, but candidates must be located in AZ or PST time zones. Please see below for details: Job Title: Healthcare Claims Analyst (Pharmacy / PBM Focus)
Pay: $27/hour
Location: Remote (AZ or PST time zone preferred)
Assignment: Contract – Expected to extend beyond 12/31
Schedule: Full-time, 40 hours/week (Standard business hours) Job Description:
In this role, you will support pharmacy benefit accuracy by analyzing prescription claims and plan setups in various systems. This position combines data analysis , problem-solving , and healthcare industry knowledge to ensure medication claims are processed correctly and efficiently. Key Responsibilities:

• Analyze PBM prescription claims and systems for medication benefit quality and accuracy
• Support internal and external stakeholders with benefit and claim information
• Identify and resolve issues with plan setups and accumulations
• Log benefit setup issues and provide regular updates on resolutions
• Communicate recommendations related to claim processing and system enhancements
• Participate in quality audits and process improvement initiatives
• Act as SME for pharmacy benefit design and setup (higher levels)

• Healthcare or PBM industry experience required
• Excel/spreadsheet proficiency is essential
• Strong data entry skills and attention to detail
• Background in medical or pharmacy claims preferred
• Ability to think analytically and troubleshoot issues
• Highly organized and able to work independently
• Experience working with Rx claims or PBM systems is a big plus

• Familiarity with benefit configuration or pharmacy plan setup
• Prior experience in a BCBSAZ or similar healthcare environment
• Knowledge of accumulations, patient pay setup, and pharmacy codes
• Ability to document and support team processes
• Experience supporting audits and reporting functions

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