Senior Functional Business Consultant- REMOTE

Lensa; Providence (RI); Remote; USD 81,000 - 138,000; Full time

Job summary

An established industry player is seeking a Senior Functional Business Consultant to join their remote team. This role involves serving as a subject matter expert in business processes and compliance, providing leadership in regulatory matters, and collaborating with internal clients. The ideal candidate will have extensive experience in business analysis and project management, particularly in healthcare or regulated environments. This position offers a competitive salary and the opportunity to make a significant impact in improving processes and client satisfaction. If you thrive in a dynamic environment and are passionate about compliance and operational excellence, this role is for you.

Qualifications

• 5+ years in business analysis or project management with a focus on compliance.
• Proven client service skills and ability to build strong relationships.

Responsibilities

• Serve as a subject matter expert in business requirements and compliance.
• Lead the adoption of operational best practices and standard procedures.

Skills

Business Analysis

Project Management

Compliance Knowledge

Client Service Skills

Interpersonal Skills

Education

Bachelor’s Degree in Business Administration

Equivalent Experience

Tools

MS Word

MS Excel

MS Project

MS PowerPoint

MS Visio

Job description

Senior Functional Business Consultant- REMOTE

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 Posting Title

Senior Functional Business Consultant- REMOTE

Job Description

The Functional Business Consultant serves as a business system or business process subject matter expert with a high level of understanding of their assigned area. This position will represent their area of expertise with regard to business system knowledge on internal and client projects, regulatory requirements, process improvement, advanced research, root cause analysis, complex issue research, documentation, advanced communications, client interaction, training, testing, ongoing system support, and developing reports and coordinating audits.

Responsibilities

• Represents assigned business system or business process as a subject matter expert in business requirements, system specifications, process flows, process change and/or project management in supporting Compliance with Medicaid requirements.
• Provide leadership to compliance professionals, role modeling Prime’s employee and leadership expectations.
• Serves as a consultant to management on laws, regulations, policies, and objectives, providing Subject Matter Expertise in areas such as Affordable Care Act, Government Programs, and Corporate Compliance.
• Advises internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements.
• Leads the adoption of operational best practices and standard operating procedures related to assigned systems or processes.
• Researches, determines root cause, and collaborates to resolve complex business and technical issues.
• Provides prompt and thorough resolution for client/member satisfaction.
• May guide, mentor, and direct team members.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in business administration, IT, or related field, or equivalent experience; HS diploma or GED required.
• At least 5 years in business analysis, project management, or process improvement, including:
• 3 years of functional experience in areas like compliance, claims, eligibility, benefits, or related fields.
• Legal authorization to work in the U.S. without sponsorship.

Additional Qualifications

• Proven client service skills and ability to build strong relationships.
• Implementation experience.
• Self-learning capabilities for new processes/software.
• Excellent interpersonal, communication, and presentation skills.
• Proficiency in MS Word, Excel, Project, PowerPoint, and Visio.

Preferred Qualifications

• 6+ years in legal or compliance roles within healthcare or a regulated industry, including Medicaid and ACA experience.
• Experience with PBM or healthcare settings.
• Knowledge of regulatory laws and guidance.
• Certifications such as CCEP, CHC, PMP are preferred.
• Strong negotiation and influencing skills.

Physical Job Requirements

• Occasional non-standard hours and travel.
• Standard physical requirements including sitting, handling, talking, hearing, reaching, standing, walking, and lifting up to 10 pounds.
• Vision abilities required include close, distance, color, peripheral, depth perception, and focus adjustment.

Reporting Structure

• Reports to a Functional Business Owner, Manager, or Director in various operational areas.

All employees must comply with security responsibilities, legal, regulatory, and internal policies.

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

For benefits details, visit our Benefits Page and click on "Benefits at a glance".

Prime Therapeutics is an equal opportunity employer and encourages diverse candidates to apply. We welcome applicants with different backgrounds and abilities, including those requiring accommodations.