Jacob Sand Email & Phone Number

•Subject Matter Expert for the Benefits Department on the development of business requirements, system specifications and process changes during a multi-department implementation of a new Prime Product Offering.•Subject Matter Expert on large employer group implementation. •Subject Matter Expert on design and requirements gathering for the Health Insurance Marketplace.•Collaborated cross-departmentally in requirements gathering for IT system enhancements.•Identified, researched… Show more •Subject Matter Expert for the Benefits Department on the development of business requirements, system specifications and process changes during a multi-department implementation of a new Prime Product Offering.•Subject Matter Expert on large employer group implementation. •Subject Matter Expert on design and requirements gathering for the Health Insurance Marketplace.•Collaborated cross-departmentally in requirements gathering for IT system enhancements.•Identified, researched and assisted in the research and trouble shooting for complex business requirement gaps.•Strong focus on client management.•Strong focus on mentorship and coaching of multiple mentees as well as leading multiple large group training sessions.•Creation and maintenance of Desk Top Procedure documentation. Show less

•Facilitated the creation and maintenance of drug lists to support new and existing business. Analyze client documentation to define needed drug list support. •Collaborated with Sr. Pharmacist to interpret project requirements provided by clients or Client Engagement and identified the technical enhancements necessary to support the requests.•Participated in project support activities and assisted with defining the business requirements necessary to facilitate client benefit and… Show more •Facilitated the creation and maintenance of drug lists to support new and existing business. Analyze client documentation to define needed drug list support. •Collaborated with Sr. Pharmacist to interpret project requirements provided by clients or Client Engagement and identified the technical enhancements necessary to support the requests.•Participated in project support activities and assisted with defining the business requirements necessary to facilitate client benefit and clinical requests. Created and modified Standard Operating Procedures (SOPs) as required.•Participated in client-facing interactions to respond to inquiries related to Benefit Design projects, including benefit enhancement and/or system changes.•Utilized the SPPS Showcase query tool to assist with quality assurance of benefit plan designs, project preparation, and error impact analysis.•Provided mentoring and Subject Matter Expert (SME) support to the Benefit Design and Quality Assurance teams.•Identified and documented system problems. Escalated system defects with a sense of urgency to avoid member disruption.•Represented Benefit Design on cross-departmental projects. Participated in workgroups, attended planning meetings and determine benefit plan set up requirements in RxClaim, as appropriate.•Supported testing needs for product development efforts, new business and system modification enhancements. Supported the cross- functional Prime benefits strategy committee by providing testing and analysis of proposed benefit plan designs.•Created, maintained, and updated BET templates. Established strong working relationship with Production Supervisor to ensure updates are handled appropriately and in a timely manner.•Maintained expert knowledge on RxClaim functionality, Benefit Edit Tool functionality, and SPSS query tool. Show less

•Utilized the web-based Benefit Edit Tool and client project intake process to receive incoming benefit design work items from clients. Evaluate standard, nonstandard and complex benefits, code and document benefits for new business and for renewal of plan design changes. •Researched and responded to internal and external referrals and inquiries regarding benefit coding or claims processing. Utilize the Prime Call Tracking database to reply to customer and pharmacy inquiries as… Show more •Utilized the web-based Benefit Edit Tool and client project intake process to receive incoming benefit design work items from clients. Evaluate standard, nonstandard and complex benefits, code and document benefits for new business and for renewal of plan design changes. •Researched and responded to internal and external referrals and inquiries regarding benefit coding or claims processing. Utilize the Prime Call Tracking database to reply to customer and pharmacy inquiries as escalated by the Contact Center. Ensure timely response to inquiries.•Performed manual system testing to verify that benefits are coded for correct claim payment information. Forward work items to the Quality Assurance staff for plan automated testing certification.•Identified and documented system problems. Escalated system defects with a sense of urgency to avoid member disruption.•Performed supportive research tasks associated with standard, non-standard and complex benefit plans.•Created default lists to support new copays, pricing, age limits, gender and day supply edits.•Conducted first reviews and provide training and mentorship to benefit design staff as requested. Show less

•Responsible for understanding specific client benefit plan designs, obtained through the Benefit Edit Tool and code them into the AS400 system. •Performed preliminary quality assurance testing to decrease overall accuracy errors and to verify correct payment information and claims processing. •Researched and responded to internal and external referrals regarding benefit coding and claims processing.•Researched possible process improvements across clients and work collectively with… Show more •Responsible for understanding specific client benefit plan designs, obtained through the Benefit Edit Tool and code them into the AS400 system. •Performed preliminary quality assurance testing to decrease overall accuracy errors and to verify correct payment information and claims processing. •Researched and responded to internal and external referrals regarding benefit coding and claims processing.•Researched possible process improvements across clients and work collectively with Account Install Analysts to improve build processes and increase client live accuracy measures. •Performed system testing to verify the benefits for plans are created and processing correctly.•Recognized and documented errors found within the system inaccordance with Prime’s policies.•Trained and mentored new Benefit Design Specialists on the build process for MN and NC clients. Show less

•Responsible for understanding specific client benefit plan designs, obtained through the Benefit Edit Tool and code them into the AS400 system. •Performed preliminary quality assurance testing to decrease overall accuracy errors and to verify correct payment information and claims processing. •Researched and responded to internal and external referrals regarding benefit coding and claims processing.•Researched possible process improvements across clients and work collectively with… Show more •Responsible for understanding specific client benefit plan designs, obtained through the Benefit Edit Tool and code them into the AS400 system. •Performed preliminary quality assurance testing to decrease overall accuracy errors and to verify correct payment information and claims processing. •Researched and responded to internal and external referrals regarding benefit coding and claims processing.•Researched possible process improvements across clients and work collectively with Account Install Analysts to improve build processes and increase client live accuracy measures. •Recognized and documented errors found within the system in accordance with Prime’s policies.•Trained and mentored new Benefit Design Specialists on the build process for MN and NC clients. Show less

•Oversaw nine projects in SIFE and appointed leaders to each project.•Compiled cost calculations for supplies used during the Sam’s Club Challenge. •Organized a mission trip to Uganda to help less fortunate children and create a stable income for a school.•Assisted in the creation of a vision and goals for an organization made up of students.•Created weekly agendas and facilitated executive board meetings and group meetings.•Worked as part of a team to create a presentation… Show more •Oversaw nine projects in SIFE and appointed leaders to each project.•Compiled cost calculations for supplies used during the Sam’s Club Challenge. •Organized a mission trip to Uganda to help less fortunate children and create a stable income for a school.•Assisted in the creation of a vision and goals for an organization made up of students.•Created weekly agendas and facilitated executive board meetings and group meetings.•Worked as part of a team to create a presentation and annual report for Regional/National Competitions.•Brainstormed, created and implemented fundraising events to sponsor club activities and travel.•Solicit donations from corporate sponsors.•Facilitated a program with a halfway house known as the Dream Center.-Worked with men who had recently spent time in jail and prison. -Helped give them a second chance by assisting them in job searches, job interviews and studying for school courses. Show less

•Responsible for the interviewing and hiring process of new workers each year.•Analyzed and assessed the department’s budget.•Communicated directly with companies through business to business operations.•Supervised workers throughout their daily tasks.

Bachelor Of Arts (B.A.), Business Management And Biology

Activities and Societies: Students in Free Enterprise (now Enactus)

Bachelor Of Arts (B.A.), Business Management And Biology

Activities and Societies: Students in Free Enterprise (now Enactus)

Education record

Activities and Societies: •Football •Wrestling •Track and Field •Letter Club