M3P Elections and Enrollment - Sr Business Analyst - Remote

About the role

The Sr. Business Analyst (M3P Elections & Enrollment) supports the Medicare Prescription Payment Plan (M3P) Election Management function within pharmacy benefit management (PBM) operations. Key responsibilities include managing and resolving election-related tickets, investigating and resolving discrepancies, coordinating with IT and cross-functional partners, and supporting CMS compliance.

Responsibilities

• Election Issue Management & Resolution
• Manage and resolve M3P election-related tickets and service requests (incidents, inquiries, provisioning requests)
• Investigate and resolve election discrepancies across systems
• Coordinate with IT and cross-functional partners to identify root causes and drive remediation
• Support CMS MARx transaction and PDE gap file analysis
• Election Processing & Data Validation
• Process and validate API and batch election file loads
• Monitor and manage the election request queue
• Perform member eligibility research
• Support regression testing and production validation
• Client Coordination & Communication
• Serve as a key point of contact for client-facing election and enrollment inquiries
• Collaborate with account management and client teams
• Identify coaching opportunities for call center representatives
• Process Documentation & Continuous Improvement
• Create, update, and maintain standard operating procedures (SOPs)
• Contribute to key controls initiatives
• Support cross-training initiatives
• Reporting & Analytics
• Prepare and deliver operational reports
• Support the development and maintenance of dashboards

Requirements

• 3+ years of experience in business analysis, enrollment/eligibility operations, or healthcare operations
• Experience evaluating business processes, identifying gaps, and driving process improvement
• Proficiency with IT service management (ITSM) or ticketing platforms
• Proven solid analytical skills with the ability to research and resolve complex member-level data discrepancies across multiple systems
• Proven excellent written and verbal communication skills
• Demonstrated ability to manage multiple priorities and meet deadlines in a fast-paced environment

Qualifications

• Experience with Medicare Part D programs, CMS regulations, and M3P or similar election/enrollment programs
• Experience working with RXclaim
• Experience building or contributing to dashboards in Power BI, Tableau, or similar business intelligence tools
• Experience with cross-functional coordination across IT, compliance, account management, and client-facing teams
• Familiarity with pharmacy benefit management (PBM) systems and election processing workflows
• Knowledge of CMS audit requirements, MARx reporting, PDE submissions, and HPMS processes

Skills

• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Ability to manage multiple tasks and meet deadlines
• Experience with IT service management or ticketing platforms
• Experience with cross-functional coordination
• Knowledge of Medicare Part D programs and CMS regulations
• Experience with pharmacy benefit management systems and election processing workflows

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contribution