Business Analyst III- Pharmacy Claims/Query Testing Specialist

4 days ago


Indianapolis, Indiana, United States Elevance Health Full time
Job Summary:

As a Business Analyst III- Pharmacy Claims/Query Testing, you will serve as the liaison between the business and IT in translating complex business needs into application software. This role is responsible for understanding the Pharmacy benefit setup and validating the configuration using test claims/query testing.

Key Responsibilities:
  • Validate Formulary, Utilization Management & Drug List setup using Test Claims/Query testing.
  • Review and provide the testing timelines to be included in the project plan.
  • Ensure adherence to committed timelines.
  • Identify and triage defects to closure working with business & adjudication teams.
  • Coordinate/collaborate with cross-functional teams that are globally dispersed.
  • Ensure compliance with mandates and project implementations.
  • Provide the latest status and metrics to the Test lead/project teams.
  • Act 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.

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.
  • 4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration strongly preferred.
  • Pharmacy Benefit Management (PBM) knowledge & Clinical formulary & Utilization Management knowledge is strongly preferred.
  • Experience working in Medicaid Line of Business is strongly preferred (Commercial & Medicare experience is a plus).
  • Experience with Data Analysis preferred.
  • Coordination/collaboration with cross-functional teams preferred.
  • Experience with Jira, Blue Print, Confluence, Expertise in MS Excel strongly preferred.
  • Automation skills (VB Macro/C#) preferred.

About Elevance Health:
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.

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