Senior Functional Business Consultant- REMOTE

Lensa; Boston (MA); Remote; USD 81,000 - 138,000; Full time

Job summary

An established industry player is looking for a Senior Functional Business Consultant to join their remote team. This role requires a deep understanding of business systems and processes, focusing on compliance with Medicaid regulations. You will provide leadership, mentor team members, and ensure high client satisfaction. The ideal candidate will have a strong background in business analysis and project management, with excellent communication skills. This position offers a competitive salary and the chance to contribute to meaningful work that impacts people's lives positively.

Qualifications

• 5+ years of experience in business analysis or project management.
• Strong client service skills and ability to build relationships.

Responsibilities

• Act as a subject matter expert for business systems, supporting compliance.
• Lead the adoption of operational best practices and resolve complex issues.

Skills

Business Analysis

Project Management

Process Improvement

Client Service Skills

Interpersonal Skills

Communication Skills

Education

Bachelor’s degree in Business or IT

High School diploma or GED

Tools

MS Office Suite

Job description

Senior Functional Business Consultant- REMOTE

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Prime Therapeutics, is seeking professionals. Apply via Lensa today!

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Overview

The Functional Business Consultant serves as a subject matter expert in business systems or processes, with a high level of understanding of their assigned area. This role involves representing their expertise in internal and client projects, regulatory compliance, process improvement, research, root cause analysis, issue resolution, documentation, communication, client interaction, training, testing, system support, reporting, and audits.

Responsibilities

• Act as a subject matter expert for assigned business systems or processes, supporting compliance with Medicaid requirements.
• Provide leadership and role modeling for compliance professionals and team members.
• Advise management on laws, regulations, policies, and objectives; serve as SME in areas like ACA, Government Programs, and Compliance.
• Guide internal clients on compliance with Medicaid regulations and contractual requirements.
• Lead the adoption of operational best practices and standard procedures related to their area.
• Research, identify root causes, and collaborate to resolve complex technical and business issues.
• Ensure prompt resolution of client and member inquiries to maintain satisfaction.
• Mentor and guide team members as needed.
• Perform other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in Business, IT, or related field, or equivalent experience; HS diploma or GED required.
• At least 5 years of experience in business analysis, project management, or process improvement, including 3 years in a relevant area (e.g., compliance, claims, eligibility).
• Legal authorization to work in the U.S. without sponsorship.

Additional Qualifications

• Strong client service skills and experience building client relationships.
• Implementation experience.
• Ability to self-learn new processes and software.
• Excellent interpersonal, facilitation, conflict management, and communication skills.
• Ability to handle multiple projects under tight deadlines.
• Proficiency in MS Office Suite.

Preferred Qualifications

• 6+ years in healthcare or pharmacy benefits, with experience in Medicaid, ACA, or government programs.
• Previous experience in PBM or healthcare.
• Knowledge of regulatory laws and guidance.
• Certifications such as CCEP, CHC, PMP are a plus.

Physical Requirements

• Occasional non-standard hours and travel.
• Prolonged sitting, use of hands, talking, hearing.
• Frequent reaching and occasional standing, walking, stooping, kneeling, crouching.
• Ability to lift up to 10 pounds occasionally.
• Vision abilities including close, distance, color, peripheral, and focus adjustment.

Reporting Structure

Reports to a Functional Business Owner, Manager, or Director in relevant departments.

All employees must adhere to security responsibilities, legal, regulatory, and internal policies.

Salary range: $81,000 - $138,000, based on experience.

For benefits details, visit our Benefits Page.

Prime Therapeutics is an equal opportunity employer, encouraging diverse candidates to apply. We value inclusivity and provide accommodations for applicants with disabilities.