Clinical PBM Systems Analyst: Drug Nomenclature & Claims

TechDigital Group; Florham Park (NJ); On-site; USD 90,000 - 150,000; Full time

Job summary

TechDigital Group in Florham Park, NJ seeks a Business Analyst/PM with PBM domain expertise to drive claims processing and drug coverage configurations. You will coordinate with business, development and testing teams to translate requirements into actionable specs and documentation.

The role leverages a clinical/pharmacist background to ensure accurate drug naming, formulary design, and compliance with ProDUR rules.

Qualifications

• Experience with PBM domain and claims processing.
• Knowledge of NCPDP D.0 standards and ProDUR rules.
• Strong requirements elicitation and translation to specs.
• Clinical/pharmacist background preferred.

Responsibilities

• PBM domain expertise applied to claims processing workflows.
• Define drug nomenclature, formulary and PDL design.
• Configure drug coverage: inclusions, exclusions & prior authorization.
• Adhere to NCPDP D.0 standards and ProDUR rules.
• Elicit requirements and translate to development/testing specs.
• Develop process workflows, use cases, and Visio documentation.

Skills

PBM Domain Expertise

Claims Processing

Requirements Elicitation

Stakeholder Collaboration

Excel Data Analysis

PowerPoint

Tools

NCPDP D.0 Standards

Visio

Excel

PowerPoint

Job description

Job Details:
• PBM Domain Expertise & Claims Processing
• FDB Drug Nomenclature, Formulary & Preferred Drug List Design
• Drug Coverage Configuration: Inclusions, Exclusions & Prior Authorization Criteria
• NCPDP D.0 Standards & ProDUR Business Rules
• Business Requirements Elicitation, Analysis & Translation
• Stakeholder Collaboration with Business, , Development & Testing Teams
• Process Workflows, Use Cases, Wireframes & Visio DocumentationClinical
• Microsoft Excel Data Analysis & Requirement Simplification
• Product Feature Documentation, Roadmap Support & PowerPoint Presentation
• Clinical / Pharmacist Background