Business Analyst, Data Operations

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Manage SFTP connections, folder structures, credentials, and user access within Couchdrop.

• Oversee the daily receipt and delivery of eligibility and accumulator files.

• Facilitate new SFTP configurations and modifications for client onboarding and TPA implementations.

• Maintain partnerships, file schedules, and inventories related to file handling.

• Design, create, and uphold automated file workflows, including monitoring and alerting systems.

• Test and document automation processes, encompassing failure handling and recovery strategies.

• Reconcile member claims with TPA and medical carrier accumulator ledgers.

• Resolve issues related to claim-level reversals, adjustments, file-cycle timing, and discrepancies in plan years.

• Collaborate with Data Operations team members to validate findings, identify root causes, and implement corrections.

• Act as the primary operational contact for TPA partners on a daily basis.

• Coordinate changes to file specifications, updates to layouts, and testing with TPAs.

• Intake, categorize, track, and prioritize issues related to files and data.

• Conduct impact analyses and communicate results to both technical and non-technical audiences.

• Maintain a dashboard or tracking tool for issues, serving as the single source of truth.

• Provide proactive updates to stakeholders throughout the issue resolution process.

• Identify, prototype, test, and implement AI-assisted data operations tools while adhering to security, privacy, and HIPAA regulations.

• Lead data operations projects from initial scoping to final delivery.

• Define project scope, milestones, ownership, dependencies, plans, risks, and status reporting.

• Maintain comprehensive documentation and identify recurring issues for automation, systemic improvements, or process enhancements.

⛳️ Requirements

• Bachelor’s degree in Business, Healthcare Administration, Information Systems, or a related field, or equivalent experience.

• At least 5 years of experience as a business analyst, data operations analyst, or in a similar role, including a minimum of 3 years in PBM, pharmacy benefits, or health plan operations.

• Practical experience with pharmacy claims adjudication platforms, including researching claims, reversals, and adjustments at the member level.

• Proficient in troubleshooting accumulator discrepancies by reconciling member claims with TPA or medical carrier accumulator ledgers.

• Familiarity with eligibility and accumulator file layouts and exchange processes.

• Experience in managing SFTP environments for healthcare data exchange; Couchdrop expertise is highly preferred.

• Proven experience in developing SFTP or file-transfer automations using a managed file transfer platform or scripting.

• Experience working directly with TPAs or other external partners to address file and data issues.

• Demonstrated project management experience leading cross-functional projects to timely completion; PMP or similar certification is advantageous.

• Experience utilizing and developing AI tools, including LLM-based assistants, prompt design, or AI-assisted automation.

• Understanding of HIPAA regulations and secure handling of protected health information (PHI).

• Experience in building and maintaining a dashboard or status-tracking tool, such as Excel, Power BI, Smartsheet, or Jira.

• Strong written and verbal communication skills.

• Excellent analytical skills with the ability to assess issue scope and impact.

• Highly organized and detail-oriented, capable of managing multiple issues, projects, and stakeholders.

• Proactive communication style.

• Alignment with AffirmedRx values of trust, accountability, and innovation.

• Willingness to travel 10%-20% of the time.

🏝️ Benefits

• Competitive compensation, including health, dental, vision, and additional benefits.

• Opportunity to influence change within the pharmacy benefits management industry.

• A culture where individuals flourish.

• Option for a remote work arrangement.

• A professional work environment that emphasizes optimal performance and collaboration.