Senior Business Analyst – Pharmacy Claims

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

📋 Description

• Assist with the implementation and configuration of PBM or drug rebate systems.

• Provide support for PBM operations and maintenance for existing accounts.

• Collaborate with pharmacy clinicians and subject matter experts to set up pharmacy systems for state clients.

• Aid in the deployment of a pharmacy payer system.

• Conduct pharmacy updates, including benefit plan design, edit/audit setup, utilization controls, PDL, configuration updates, and automatic prior authorization parameters.

• Define, document, and communicate pharmacy business requirements and anticipated impacts to operations staff, clients, project managers, and technical teams.

• Develop business rules and configuration requirements in collaboration with clients.

• Analyze, plan, design, document, or propose business process enhancements that support client technology objectives.

• Verify requirements through the approval and validation of test results.

• Utilize Excel or SQL along with basic analytical or relational database tools to assess the anticipated impact of work.

⛳️ Requirements

• A minimum of 6 years of experience in pharmacy operations, business analysis, or pharmacy technician positions.

• Preferred knowledge of Medicaid and Medicare programs.

• Strong grasp of pharmacy claims processing, payer systems, prior authorization workflows, and NCPDP standards.

• Experience in testing point-of-sale (POS) pharmacy claims.

• Familiarity with drug databases and file structures, including FDB, Medi-Span, and Micromedex.

• Advanced analytical and technical capabilities, encompassing Excel, SQL, data analysis, requirements mapping, and system configuration concepts.

• Ability to tackle complex business challenges, enhance processes, manage priorities autonomously, and communicate effectively with business, technical, and executive stakeholders.

• Video cameras are required to be used during all interviews and throughout the initial week of orientation.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Up to 10% travel for client meetings, requirement evaluations, or implementations.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Equal opportunity employment.