Senior Benefits Configuration Tester

Responsibilities

• Organize testing suites, create test plans, and submit moderately difficult test cases to validate the accuracy of complex benefit configuration setups.
• Serve as a key liaison with senior members of the Benefit Operations team, actively communicating to resolve configuration discrepancies, clarify plan designs, and report actionable insights back to the testing team.
• Provide support, guidance, and peer review for junior team members to ensure testing accuracy, helping them understand SmithRx claims adjudication systems and upstream/downstream processes.
• Handle Advanced Logic Validation such as Clinical/Prior Authorization and Financial Accumulators. Ensuring patient out-of-pocket maximums and cost-shares remain accurate.
• Document detailed defect reports for issues uncovered during testing and assist in the development of process improvements focusing on efficiency and accuracy.

Requirements

• Minimum of 2-4 years of related experience in benefits configuration or testing in healthcare.
• Associate degree or equivalent work experience.
• Strong understanding of benefit design standards, including HIPAA, NCPDP, and SmithRx internal business standards.
• Moderate skills in Microsoft Excel.
• Ability to work with little instruction on daily work, relying on general instructions only for newly introduced assignments.
• Strong critical thinking skills, such as analyzing data, drawing logical conclusions, and applying smart solutions to moderately difficult situations.
• Communicate effectively (written, verbal/presentation, and active listening) to successfully act as a liaison and collaborate cross-functionally.

Nice-to-Haves

• PBM or managed care experience.