Business Analyst With Pharmacy Benefit Management - Remote

About the Role

We are looking to onboard a Senior Business Analyst in either a Manager or Individual Contributor role, depending on experience level. This person will leverage deep PBM domain expertise to guide the roadmap and feature enhancements for the Client PBM product suite. The role serves as a bridge between business/clinical users (e.g., pharmacists) and the technical team (developers and testers).

Qualifications

• Experience Level: Ideally 10+ years in the PBM domain (claims processing-related). Willing to consider less experienced candidates who demonstrate deep PBM expertise.
• PBM Subject Matter Expertise:
  • Deep understanding of Pharmacy Benefit Management (PBM) business processes, including claims adjudication, data-related processes (e.g., eligibility, provider, drug, formulary data, drug utilization reviews), and their interconnections.
  • Experience with electronic prescriptions and prior-authorization standards is a strong plus.
  • Deep understanding of NCPDP PBM standards; familiarity with CMS regulations for state Medicaid pharmacy programs is a plus.
  • Expertise in FDB (First Databank) drug nomenclature and its application in designing/configuring drug coverage (inclusions/exclusions/PA criteria) or building formularies/preferred drug lists. MEDISPAN experience is acceptable as an alternative.
  • Awareness of current industry trends and evolving standards.
• College degree preferred, though industry experience may substitute.
• Candidates with a strong clinical background (e.g., pharmacists) and some BA experience are welcome, provided they are willing to transition to a full-fledged BA role with in-house training.
• Non-Domain Expertise:
  • Understanding of the Software Development Life Cycle (SDLC), including requirements management.
  • Experience using Agile tools for reverse engineering, new designs, and impact analysis.
  • Ability to capture, document, and manage requirements using requirements management tools.
  • Proficiency in documenting business processes using tools like Visio, PowerPoint, Excel, and Word, and synthesizing requirements into user stories, decision tables, or other formats.
  • Excellent communication and writing skills.
  • Experience with SQL queries and understanding of data models is a strong plus.
  • Team player willing to share knowledge and support cross-functional teams (e.g., developers, QA testers).

Responsibilities

• Provide PBM subject matter expertise to both client (development/testing teams) and non-client stakeholders (e.g., customers).
• Own the creation of requirements specifications and design documents (e.g., wireframes, decision tables) to guide developers in producing technical specifications.
• Configure drug plan benefits (e.g., covered drugs, pricing, PA requirements) using the client PBM system.
• Interact with business and clinical users to elicit and understand requirements, then translate them into formats consumable by development and testing teams.