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Compensation / Benefits Analyst
Portland, ME
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8:30am - 5pmMay work remotely, but need to be able to commute to Portland, MaineAbout the RoleWe are seeking a detail-oriented and customer-focused Pharmacy Benefits Specialist to support pharmacy benefit operations, system administration, and member services for our healthcare programs. This role serves as a subject matter expert for pharmacy benefits and plays an integral part in benefit configuration, quality assurance, regulatory compliance, member support, and pharmacy-related process improvement initiatives.
The ideal candidate will have experience in healthcare benefits, pharmacy operations, or pharmacy benefit management (PBM) environments and possess strong analytical, organizational, and communication skills.
Key Responsibilities Document, research, and triage pharmacy benefit-related inquiries. Process and enter prior authorizations within pharmacy and PBM systems. Ensure accuracy of pharmacy benefit plan design and system configuration. Serve as the pharmacy benefits subject matter expert for internal teams. Participate in benefit implementation projects, configuration updates, and end-to-end testing activities. Conduct quality assurance reviews and validate pharmacy benefit coding and system setup. Develop and deliver training for pharmacy staff and health plan personnel. Create and maintain training materials, reference guides, job aids, and FAQs. QualificationsEducation Associate degree required, or an equivalent combination of education and relevant work experience. Experience Minimum 2 years of administrative, business, healthcare, or related experience required. Healthcare benefits experience preferred. Pharmacy Technician experience strongly preferred. Experience working with Pharmacy Benefit Management (PBM) systems is a plus. Knowledge Understanding of medical terminology. Knowledge of generic and brand-name medications. Familiarity with PBM processes and third-party pharmacy billing. Skills & Competencies Excellent customer service skills. Strong verbal, written, and interpersonal communication abilities. Analytical problem-solving skills and attention to detail. Strong organizational and multitasking capabilities. Ability to collaborate effectively with internal and external stakeholders. Proficiency in data review, reporting, and reconciliation activities.
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