Pharmacy Claims Business Analyst III
3 weeks ago
Job Summary:
The Business Analyst III will serve as the liaison between the business and IT, 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 testing timelines to be included in the project plan.
- Identify and triage defects to closure working with business & adjudication teams.
- 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.
Requirements:
- BA/BS and minimum of 5 years business analysis experience.
- 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.
- 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.
What We Offer:
- 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.
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.
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