Pharmacy Business Analyst III

Global Trust Recruitment; United States; Hybrid; USD 73,000 - 124,000; Full time

Job summary

Global Trust Recruitment is seeking a Business Analyst III to serve as the liaison between business teams and Pharmacy/PBM partners, translating complex needs into actionable requirements for the coding platform, and ensuring alignment with pharmacy benefit design and testing.

The role analyzes complex data, develops project plans, coordinates cross-functional resources, oversees UAT, and creates periodic reports.

Qualifications

• Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
• Candidates must reside within 50 miles or 1-hour commute each way of our clients relevant Health location.
• For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $72,576 to $124,416
• In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, and equity stock purchase, contribution (all benefits are subject to eligibility requirements)
• The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company

Responsibilities

• The Business Analyst III is responsible for serving as the liaison between the business, and internal and external Pharmacy and PBM partners in translating complex business needs into operational pharmacy benefit application of requirements into coding platform
• Analyzes complex pharmacy book of business needs to determine optimal means of meeting those account-specific needs
• Determines specific pharmacy account business application requirements to address complex business needs
• Develops project plans and identifies and coordinates resources, involving those outside the unit
• Works with internal/external stakeholders to ensure requirements will be incorporated into pharmacy benefit design and testing
• Acts as a resource to cross-functional stakeholders to address questions/issues relative to pharmacy benefit operations and execution
• May provide direction and guidance to team members and serve as an expert for the team
• Provide support for the development and administration of specialized pharmacy benefit functions including pharmacy benefit builds, system functionality and capability consultation, adjudication logic, and pre and postproduction auditing
• Leads the preparation and submission of detailed updates of benefit changes to the Pharmacy Benefit Manager (PBM),
• Oversees the design and execution of user acceptance testing (UAT) of changes ensures such changes are implemented on time, and coordinates post-implementation verification that claims are processed as intended
• Support cross-functional teams to ensure the accuracy of pharmacy claims activity and sustain pharmacy benefit integrityAnalyze data and summarize performance using summary statistical procedures
• Create and publish periodic reports, as well as any necessary ad hoc reports
• May require taking pharmacy benefits issue/escalation(s) and devising best way to develop appropriate diagnostic and/or tracking data that will translate pharmacy benefit configuration and design into integrity-driven resolution
• Performs detailed analysis to define root cause for reported issues and facilitate issue resolution
• Analyzing, reporting, and developing recommendations on data related to multiple, varied business metrics
• This position supports a sensitive, high-touch book of business with strategic demands and precise execution required; and is a functionally demanding role with both technical and operational deliverable
• Unless specified as primarily virtual by the hiring manager, associates are required to work at our clients Health location at least once per week, and potentially several times per week

Skills

Business analysis

Stakeholder collaboration

Requirements gathering

Education

BA/BS degree

Job description

The largest for-profit managed health care company in the Blue Cross Blue Shield Association-Remote/Hybrid-Full Time

Qualifications

• Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background
• Candidates must reside within 50 miles or 1-hour commute each way of our clients relevant Health location
• For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $72,576 to $124,416
• In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, and equity stock purchase, contribution (all benefits are subject to eligibility requirements)
• The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company

Responsibilities

• The Business Analyst III is responsible for serving as the liaison between the business, and internal and external Pharmacy and PBM partners in translating complex business needs into operational pharmacy benefit application of requirements into coding platform
• Analyzes complex pharmacy book of business needs to determine optimal means of meeting those account-specific needs
• Determines specific pharmacy account business application requirements to address complex business needs
• Develops project plans and identifies and coordinates resources, involving those outside the unit
• Works with internal/external stakeholders to ensure requirements will be incorporated into pharmacy benefit design and testing
• Acts as a resource to cross-functional stakeholders to address questions/issues relative to pharmacy benefit operations and execution
• May provide direction and guidance to team members and serve as an expert for the team
• Provide support for the development and administration of specialized pharmacy benefit functions including pharmacy benefit builds, system functionality and capability consultation, adjudication logic, and pre and postproduction auditing
• Leads the preparation and submission of detailed updates of benefit changes to the Pharmacy Benefit Manager (PBM),
• Oversees the design and execution of user acceptance testing (UAT) of changes ensures such changes are implemented on time, and coordinates post-implementation verification that claims are processed as intended
• Support cross-functional teams to ensure the accuracy of pharmacy claims activity and sustain pharmacy benefit integrityAnalyze data and summarize performance using summary statistical procedures
• Create and publish periodic reports, as well as any necessary ad hoc reports
• May require taking pharmacy benefits issue/escalation(s) and devising best way to develop appropriate diagnostic and/or tracking data that will translate pharmacy benefit configuration and design into integrity-driven resolution
• Performs detailed analysis to define root cause for reported issues and facilitate issue resolution
• Analyzing, reporting, and developing recommendations on data related to multiple, varied business metrics
• This position supports a sensitive, high-touch book of business with strategic demands and precise execution required; and is a functionally demanding role with both technical and operational deliverable
• Unless specified as primarily virtual by the hiring manager, associates are required to work at our clients Health location at least once per week, and potentially several times per week

We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, or marital status.

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