Sr Test Analyst PBM

Elevance Health; Independence Township (OH); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health, via CarelonRx, seeks a Sr Test Analyst PBM to bridge business needs and IT, ensuring accurate setup and validation of pharmacy benefits systems.

The role collaborates with cross-functional teams to validate formulary, utilization management, and drug lists, translating complex requirements into effective test plans and executions.

Qualifications

• Pharmacy Benefit experience & Clinical knowledge.
• 4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting Pharmacy.
• Medicaid experience is highly desired; Commercial/Medicare a plus.
• Strong data analysis and testing capabilities.

Responsibilities

• Translate complex business needs into testable requirements.
• Validate Formulary, Utilization Management & Drug List setup using Claims/Query testing.
• Collaborate with business and adjudication teams to resolve defects.
• Coordinate with cross-functional teams to ensure test coverage.

Skills

Pharmacy Benefits

Medicaid/Medicare

Data Analysis

Communication Skills

Test Automation Tools

Jira

Confluence

MS Excel

VB Macro/C#

Education

BA/BS degree

Tools

Jira

Confluence

MS Excel

Job description

Sr Test Analyst PBM

Hybrid: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health.

The Senior Test Analyst PBM is responsible for serving as the liaison between the business and IT in translating complex business needs into application software. Ensures the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components.

How you will make an impact:

• Ensure the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components.

• Understand the Pharmacy benefit setup & validate the configuration to ensure the accurate setup using Claims/Query testing.

• Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

• Identify, triage, and collaborate with business and adjudication teams to resolve defects efficiently and effectively.

• Work closely with globally dispersed cross-functional teams to ensure successful coordination and collaboration.

• Analyzes complex end user needs to determine optimal means of meeting those needs.

• Determines specific business application software requirements to address complex business needs.

• Develops project plans and identifies and coordinates resources, involving those outside the unit.

• Works with programming staff to ensure requirements will be incorporated into system design and testing.

• Acts as a resource to users of the software to address questions/issues.

• May provide direction and guidance to team members and serves as an expert for the team.

Minimum Requirements:

• 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.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Preferred Skills, Capabilities, and Experiences:

• Pharmacy Benefit experience & Clinical knowledge.

• 4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration.

• Significant experience working in the Medicaid line of business is highly desired, with additional experience in Commercial or Medicare being a plus.

• Proficiency in Data Analysis.

• Strong communication, problem-solving, facilitation, and analytical skills.

• Experience preparing and presenting testing status and metrics reports to stakeholders.

• Experience collaborating within matrix team; familiarity with Agile methodologies.

• Experience with test automation tools and test data management.

• Experience with Jira, Confluence, Expertise in MS Excel.

• Automation skills (VB Macro/C#).

• Knowledge of systems capabilities and business operations.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k)+match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).