Network Analyst

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

📋 Description

• Execute the assigned benefit plan, including pricing, network, and reimbursement configurations.

• Carry out manual pricing adjustments, MAC updates, pricing table revisions, and related operational tasks.

• Verify pricing setups, reimbursement logic, and the accuracy of configuration outputs.

• Investigate discrepancies in pricing or configurations, document results, and escalate any associated risks or inquiries.

• Assist in the ongoing maintenance of client pricing, network configurations, and operational records.

• Aid in the implementation of new clients, renewals, and plan modifications through configuration, pricing, testing, and validation efforts.

• Adhere to QA protocols for benefit plan setups, pricing configurations, reimbursement logic, and claim adjudication results.

• Record implementation outcomes, testing results, defects, remediation actions, and lessons learned.

• Collaborate with Network Operations, Implementation, Client Experience, Product, and other internal teams.

• Utilize Excel and reporting tools to analyze claims, pricing, utilization, reimbursement, and client performance metrics.

• Conduct ad-hoc analysis and probe into pricing, reimbursement, and operational discrepancies.

• Compile summaries of findings, unresolved questions, and suggested next steps.

• Develop and maintain process documentation, configuration notes, implementation checklists, QA evidence, MAC update templates, and operational records.

• Follow established SOPs and contribute to process enhancements.

• Report status updates, risks, obstacles, and inquiries to leadership and cross-functional partners.

⛳️ Requirements

• Bachelor’s degree required or equivalent relevant work experience as assessed by HR and business leadership.

• A minimum of 2 years of experience, preferably in PBM operations, healthcare operations, benefit plan setup, pricing configuration, reimbursement operations, claim adjudication, or a related field.

• Familiarity with benefit plans, pricing, reimbursement, network, claim, or other operational configuration processes.

• Exceptional attention to detail with the capability to perform manual configuration or pricing updates accurately.

• Ability to operate independently, manage assigned tasks, adhere to documented procedures, and escalate questions or risks when necessary.

• Intermediate to advanced proficiency in Microsoft Excel, including formulas, lookups, pivot tables, data validation, and large dataset analysis.

• Strong analytical and mathematical problem-solving abilities with the skill to investigate variances, validate outputs, and present findings clearly.

• Excellent written and verbal communication skills, including the capacity to document work effectively and articulate operational issues to internal stakeholders.

🏝️ Benefits

• Paid Time Off

• 401(k) program

• Health Insurance including Dental & Vision coverage

• Health Savings Account

• Employee Assistance Program