PBM Benefits Testing Analyst

Genesis10 is currently seeking a PBM Benefits Testing Analyst for a contract position with a major healthcare company located in Orange County, CA. This is a 24+ month contract opportunity. This position is fully remote.

Compensation:  $62.00 - 66.00 per hour, W2.
 
Summary
This role will support benefits testing, validation, and analysis activities as part of large-scale testing initiatives. The work requires an experienced tester who understands benefit structures, testing methodologies, and analysis of claim outcomes within a Pharmacy Benefit Management (PBM) environment. The focus will be on complex claim-rejection scenarios that require strong analytical and troubleshooting skills.
 
Responsibilities:

• Support benefits testing, validation, and analysis for large testing initiatives
• Perform execution, research, defect resolution, and summarize results for health plan claims, and compare testing
• Analyze and troubleshoot complex claim rejection scenarios in an end-to-end testing process
• Conduct research to validate whether claim rejections are errors or accurate based on benefit conversion
• Review benefits to determine if a claim should have been rejected
• Analyze large data sets to identify trends and issues

• Experience in benefit testing, claim validation, and PBM testing environments
• Detailed Pharmacy Benefit Management (PBM) experience with claims quality
• Strong analytical, research, and troubleshooting skills
• Experience researching rejected claims by reviewing plan benefits
• Ability to interpret claim benefits to understand rejection reasons
• Proficiency with Excel, including macros, VLOOKUPs, and analyzing large data sets
• Experience with PBM benefit systems or claims engine applications

• Access to hundreds of clients, most of whom have been working with Genesis10 for 5-20+ years.
• The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years.
• Access to an experienced, caring recruiting team (more than 7 years of experience, on average)
• Behavioral Health Platform
• Medical, Dental, Vision
• Health Savings Account
• Voluntary Hospital Indemnity (Critical Illness & Accident)
• Voluntary Term Life Insurance
• 401K
• Sick Pay (for applicable states/municipalities)
• Commuter Benefits (Dallas, NYC, SF, and Illinois)

For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at www.genesis10.com
 
Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.