Experienced Application Architect

Summary

The Technical Analyst plays a critical role in bridging business needs with technical execution across one or more functional domains (e.g., Member, Provider, Claims/UM, Pharmacy, Finance, Plan, or VUE360).

Responsibilities

• Understand business requirements at a detailed level and translate them into technical specifications and data models, including pharmacy claims adjudication logic, pricing methodologies, DUR edits, and PA workflows.
• Support business analysts with insight into how system data and integrations meet operational and policy needs, including pharmacy benefit rules and pharmacy claims data structures.
• Apply healthcare and pharmacy domain knowledge to validate logic, dependencies, and downstream impacts of technical decisions.
• Use advanced SQL skills to extract, analyze, and validate data to support solutioning, testing, and quality assurance, including pharmacy claims data elements such as NDCs, quantities, units, pricing fields, and DUR indicators.
• Interpret and utilize Data Element Dictionaries (DEDs) to understand data structures and relationships across modules, including pharmacy-specific data dictionaries.
• Analyze and document data flows, integration logic, and technical dependencies across internal systems and external interfaces, including NCPDP pharmacy interfaces and pharmacy PA systems.
• Serve as a liaison between business users, developers, QA, and configuration teams to ensure shared understanding of requirements, including pharmacy-specific rules and adjudication logic.
• Document and communicate technical decisions, risks, and impacts clearly and concisely to stakeholders, including pharmacy program impacts.
• Develop detailed technical solution models and recommend scalable approaches that align with enterprise architecture and platform capabilities, including pharmacy claims and pharmacy benefit configurations.
• Mentor junior technical analysts on data standards, SQL best practices, and documentation expectations, including pharmacy claims data structures and pricing logic.
• Provide analytical support during defect resolution, system configuration validation, and pre-deployment quality checks, including pharmacy claims adjudication and DUR logic validation.

Requirements

• 3–5 years of experience in a technical analyst, data analyst, or healthcare systems analyst role.
• Advanced SQL skills, including experience with joins, data transformations, and large dataset manipulation, including pharmacy claims datasets.
• Strong understanding of healthcare systems and Medicaid concepts, including Medicaid pharmacy claims processing, NDC-based pricing, DUR edits, prior authorization workflows, and pharmacy benefit rules.
• Familiarity with Data Element Dictionaries (DEDs), interface specifications, and integration design, including pharmacy-related interfaces such as NCPDP.
• Excellent communication and documentation skills.
• Experience working in SDLC and Agile environments preferred.
• Understanding of system implementation in cloud platforms (AWS/Azure/Google Cloud) is a plus.

Qualifications

• Master’s degree in Computer Science, Information Technology, or a related field.
• Professional certifications in healthcare IT (e.g., RHIA, RHIT, CPHIMS, etc.) preferred.

Skills

• Advanced SQL skills, including experience with joins, data transformations, and large dataset manipulation, including pharmacy claims datasets.
• Strong understanding of healthcare systems and Medicaid concepts, including Medicaid pharmacy claims processing, NDC-based pricing, DUR edits, prior authorization workflows, and pharmacy benefit rules.
• Familiarity with Data Element Dictionaries (DEDs), interface specifications, and integration design, including pharmacy-related interfaces such as NCPDP.
• Excellent communication and documentation skills.
• Experience working in SDLC and Agile environments preferred.
• Understanding of system implementation in cloud platforms (AWS/Azure/Google Cloud) is a plus.

Benefits

• Comprehensive health benefits.
• Flexible vacation policy.
• 401(k) employer match.
• Education assistance.

Pay

The pay range for this position is $95,100.00 - $135,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.