Business Analyst III- Pharmacy Claims/Query Testing
Elevance Health

Job Info

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Business Analyst III

Location: This position will work a hybrid model (1-2 days/week in office). The ideal candidate will live within 50 miles from one of our posted Elevance Health locations.

A proud member of the Elevance Health family of companies, CarelonRx (formerly IngeinoRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

The Business Analyst III is responsible for serving as the liaison between the business and IT in translating complex business needs into application software.

How you will make an impact:

• Understand the Pharmacy benefit setup & validating the configuration using test claims/query testing.
• Validation of Formulary, Utilization Management & Drug List setup using Test Claims/Query testing.
• Review & provide the testing timelines to be included in the project plan.
• Ensure the adherence to committed timelines.
• Identify & triage defects to closure working with business & adjudication teams.
• Coordination/collaboration with cross functional teams that are globally dispersed.
• Ensure the compliance with mandates and project implementations.
• Provide the latest status and metrics to the Test lead/project teams.
• Acts as a resource to users of the software to address questions/issues.
• May provide direction and guidance to team members and serves as an expert for the team.

Minimum Requirements:

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• 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.
• Coordination/collaboration with cross functional teams preferred.
• Experience with Jira, Blue Print, Confluence, Expertise in MS Excel strongly preferred.
• Automation skills (VB Macro/C#) preferred.

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