22 Jul
Business Analsyt
California, Sanjose , 95113 Sanjose USA

Vacancy expired!

HiHope you are doing greatI found your resume from one of the job portals and it seems really a good match with the requirement so please have a look at the requirement and let me know if you are comfortable with the requirement. Do send me an updated copy of your resumeJob Role:- Business AnalystLocation- RemoteDuration- Long Term ContractResponsibilitiesAs 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(1) At least 2 years working experience in Business engagements in healthcareindustry, preferably in Pharmacy Benefit Manager (PBM) / Pharmacy spectrum(2) Pharmacy Benefit Manager (PBM) / Pharmacy spectrum as Business Analyst - with core Business team(3) More than 3 years total healthcare experience(4) Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)a. Subrogation Claim Processingb. Member Eligibilityc. Product/Benefitd. Claim Processinge. Prior Authorizationf. Formularyg. Consumer/Member portals & Mobility applicationsh. Medicare/Medicaid, PDE, Encounteri. Coordination of Benefitsj. NCPDP layout and EDI Rx transactionsk. Specialty Pharmacyl. Mail order Pharmacy(5) Excellent knowledge in Elicitation of Business requirements by collaborating withBusiness sponsors(6) Efficient in translating Business Requirements into Functional and Non-FunctionalRequirements(7) Strong communication skills who can be engaged with business stakeholders asPharmacy domain SME(8) Experienced in User Acceptance Testing (UAT)(9) Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc) Good to have(10)Working experience with PBM migration with any of the leading Payers(11)Certified in Agile practices - SAFe Practitioner, Scrum Master etc(12)Certifications in Business Analysis Thanks and Regards,Shubham JainTechnical RecruiterP: 732-944-0141: E: Shubham.j@e-solutionsinc.com 2N Market St, Suite # 400, San Jose, CA- 95113www.e-solutionsinc.comUSA | CANADA | UK | SINGAPORE | MALAYSIA | INDIADisclaimer: E-Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. We especially invite women, minorities, veterans, and individuals with disabilities to apply. EEO/AA/M/F/Vet/Disability.

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