Job summary:

Job description:

**** Webcam interview; Initial remote due to covid then onsite ***

Responsibilities

As a Pharmacy Benefit Management (PBM) Business Analyst, you will

• Process the PBM claims based on business rules
• Engage appropriate PBM business stakeholders in reviewing business scenarios and revise the business rules as required
• Collaborate with other business functional groups including (but not limited to)
• Membership and Enrolments, Benefit Configuration, Pricing and Networks, Formulary management,
• Drug Discounts, Finance and Reporting, Downstream processing areas
• Run query from data warehouse applications and claims processing application (s) to triage the
• reported claims and related issues
• Facilitate and/or actively participate in meetings related to the designated project/s, both
• locally and internationally, with clients and/or partners
• Accurately track and report claim status
• Support claims review and audit activities

 Requirements

• At least 2 years working experience in Business engagements in healthcare
• industry, preferably in Pharmacy Benefit Manager (PBM) / Pharmacy spectrum
• Pharmacy Benefit Manager (PBM) / Pharmacy spectrum as Business Analyst – with core Business team
• More than 3 years total healthcare experience
• Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)
  • Subrogation Claim Processing
  • Member Eligibility
  • Product/Benefit
  • Claim Processing
  • Prior Authorization
  • Formulary
  • Consumer/Member portals & Mobility applications
  • Medicare/Medicaid, PDE, Encounter
  • Coordination of Benefits
  • NCPDP layout and EDI Rx transactions
  • Specialty Pharmacy
  • Mail order Pharmacy
• Excellent knowledge in Elicitation of Business requirements by collaborating with
• Business sponsors
• Efficient in translating Business Requirements into Functional and Non-Functional
• Requirements
• Strong communication skillset who can be engaged with business stakeholders as
• Pharmacy domain SME
• Experienced in User Acceptance Testing (UAT)
• Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc)

 Good to have

• Working experience with PBM migration with any of the leading Payers
• Certified in Agile practices - SAFe® Practitioner, Scrum Master etc
• Certifications in Business Analysis

Contact the recruiter working on this position:

The recruiter working on this position is Abaka Kartik(Shaji Team)
His/her contact number is +(1) (571) 2812089
His/her contact email is karthik.abaka@msysinc.com

Our recruiters will be more than happy to help you to get this contract.