Serve You Custom Prescription Management
Benefit Coding Specialist
Serve You Custom Prescription Management, Milwaukee, Wisconsin, United States, 53244
About the Organization
Open Date 8/28/2025
Full-Time/Part-Time Full-Time
Description
Serve You Rx
is looking for someone to join our dynamic team as a
Benefit Coding Specialist , where your attention to detail and problem-solving skills will directly impact the accuracy and success of our pharmacy benefit services. In this vital role, you'll translate client needs into smart, effective system configurations that ensure smooth and accurate claim processing. You'll play a key role in maintaining benefit plans, pricing structures, formularies, and clinical programs - all while collaborating across departments to resolve issues and improve processes. If you're looking for a role that combines analytical thinking, healthcare impact, and meaningful collaboration, this is your opportunity to grow with a company that values precision, innovation, and teamwork.
This is a remote position.
What You'll Do:
As the Benefit Coding Specialist, you will: Analyze standard and customized coding requests and work with internal teams to obtain the accurate and complete plan documentation needed to code client intent into the pharmacy claim adjudication system. Implement new and maintain existing benefit plans, pricing, and networks in the pharmacy claim adjudication system, consistent with the direction and intent set forth by the client or Serve You Rx. Maintain the Serve You Rx formularies and clinical program offerings in the pharmacy claim adjudication system. Perform pre- and post-implementation claim testing and other configuration quality reviews to ensure accurate claim adjudication and adherence to standard and custom design requirements. Identify discrepancies, inaccuracies and unintended consequences, and take corrective action. Research and respond to claims processing and system configuration inquiries from internal departments. Proactively identify setup service issues and escalate to Benefit Coding Specialist II for immediate review and resolution. Accurately configure non-adjudicated services and fees across multiple systems. Complete department or corporate projects as assigned. Perform other duties as assigned. Qualifications:
Associate's degree or equivalent combination of education and job-related experience. Two or more years of prior employee benefits or pharmacy/medical claims processing experience. Prior PBM experience in a benefit configuration role. (preferred) Certified Pharmacy Technician (CPhT) certification. (preferred) Prior PBM experience in a benefit configuration role. (preferred) Knowledge of RxClaim or other PBM adjudication systems. (preferred) Experience in testing and quality assurance. (preferred)
Why Serve You Rx?
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
The company offers generous benefits to include: medical (HMO and PPO), dental, vision, 401k, HSA, identity theft and legal coverage, pet insurance, paid parental leave, and 18 days of paid time off in your first year.
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
This position is currently accepting applications.
Open Date 8/28/2025
Full-Time/Part-Time Full-Time
Description
Serve You Rx
is looking for someone to join our dynamic team as a
Benefit Coding Specialist , where your attention to detail and problem-solving skills will directly impact the accuracy and success of our pharmacy benefit services. In this vital role, you'll translate client needs into smart, effective system configurations that ensure smooth and accurate claim processing. You'll play a key role in maintaining benefit plans, pricing structures, formularies, and clinical programs - all while collaborating across departments to resolve issues and improve processes. If you're looking for a role that combines analytical thinking, healthcare impact, and meaningful collaboration, this is your opportunity to grow with a company that values precision, innovation, and teamwork.
This is a remote position.
What You'll Do:
As the Benefit Coding Specialist, you will: Analyze standard and customized coding requests and work with internal teams to obtain the accurate and complete plan documentation needed to code client intent into the pharmacy claim adjudication system. Implement new and maintain existing benefit plans, pricing, and networks in the pharmacy claim adjudication system, consistent with the direction and intent set forth by the client or Serve You Rx. Maintain the Serve You Rx formularies and clinical program offerings in the pharmacy claim adjudication system. Perform pre- and post-implementation claim testing and other configuration quality reviews to ensure accurate claim adjudication and adherence to standard and custom design requirements. Identify discrepancies, inaccuracies and unintended consequences, and take corrective action. Research and respond to claims processing and system configuration inquiries from internal departments. Proactively identify setup service issues and escalate to Benefit Coding Specialist II for immediate review and resolution. Accurately configure non-adjudicated services and fees across multiple systems. Complete department or corporate projects as assigned. Perform other duties as assigned. Qualifications:
Associate's degree or equivalent combination of education and job-related experience. Two or more years of prior employee benefits or pharmacy/medical claims processing experience. Prior PBM experience in a benefit configuration role. (preferred) Certified Pharmacy Technician (CPhT) certification. (preferred) Prior PBM experience in a benefit configuration role. (preferred) Knowledge of RxClaim or other PBM adjudication systems. (preferred) Experience in testing and quality assurance. (preferred)
Why Serve You Rx?
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
The company offers generous benefits to include: medical (HMO and PPO), dental, vision, 401k, HSA, identity theft and legal coverage, pet insurance, paid parental leave, and 18 days of paid time off in your first year.
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
This position is currently accepting applications.