Description

Act as the subject matter expert bridging pharmacy benefits management (PBM) requirements with technical system implementations. You will own the end-to-end business analysis lifecycle for large Federal or State programs, ensuring technical solutions align with complex regulatory and operational needs.

Responsibilities

• Evaluate existing business processes to identify improvement areas and coordinate software solution implementations.
• Gather, document, and trace business requirements and project deliverables throughout the system development life cycle (SDLC).
• Design system integrations and interfaces, managing user acceptance testing (UAT), documentation, and defect management.
• Write complex SQL queries to extract data from database tables and generate reports for stakeholders.
• Collaborate with business units, vendors, and internal teams to manage competing tasks and priorities effectively.

Required Skills

• 4+ years of Pharmacy Benefits Management (PBM) business and system experience.
• Deep domain knowledge of PBM statutes, rules, and modules.
• Proven experience working on large Federal or State healthcare programs.
• Proficiency in SQL for database querying and reporting.
• Knowledge of Drug Rebate Processing, RetroDUR, EDI, X12, HL7, HIPAA PHI, and ICD-10.
• Experience with system integration design and interface management.
• Proficiency in Microsoft Office Suite (Word, Excel, Visio, PowerPoint, Project, Outlook, OneNote).
• Degree in any field.

Preferred Skills

• Managed Care and Medicaid experience.
• Project Management experience and familiarity with System Integrator Platforms.
• Experience with JIRA, SCRUM, and Agile methodologies.

Key Skills

Education

Any graduate