Business Analyst with Pharmacy Benefits Management

Job Description

We are looking to onboard a Senior Business Analyst in Manager role or Individual contributor depending on experience level.

This person will have deep PBM domain expertise and who will help guide the roadmap and feature enhancements for the PBM product suite.

This person will serve as a bridge between the Business users and/or Clinical end users (Pharmacists) and the technical team (Developers and Testers primarily).

Minimum Qualifications

• Ideally 10+ years experience working in PBM domain (Claims processing related).
• Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.
• Candidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists.
• Candidate should have a good understanding of PBM Claims processing and related NCPDP standards (D.0 at least) and common business rules around Drug Utilization (ProDUR related).
• College degree is preferred. Industry experience can be considered as substitute.
• Candidates who have strong Clinical background e.g. Pharmacists.

Job Responsibilities

• Provide PBM Subject Matter Expertise for both (Development and Testing team) and non-stakeholders (e.g. Customers).
• Own responsibility for configuring drug plan benefits (inclusions/exclusions/PA requirements) using PBM system.
• Interact with business and clinical users to elicit and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team.
• Good working knowledge on creating Process workflow or Use Cases, Powerpoint slides, Wireframes, Workflows using Microsoft Visio, Analyze data using Microsoft Excel is needed to be effective at Requirements management, Translating and simplifying requirements.
• Document product features/requirements related documentation, prepare roadmaps (with aid of tools such as Visio, Power point).