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Executive Order 11246, Section 503 & VEVRAA EOE, including disability/vets
Business Analyst Healthcare Waterfall Agile Methodologies Analyst
(Jobs in Mason,
 
Requirement id 101616
Job title Analyst
Job location in Mason, OH
Skills required Business Analyst, Healthcare, Excellent Oral And Written Communication Skills, Waterfall Agile Methodologies
Open Date 30-Dec-2019
Close Date
Job type Contract
Duration 6 Months
Compensation DOE
Status requirement ---
Job interview type ---
Apply
   Email Recruiter: coolsoft
Job Description Analyst: Business Analyst, Healthcare, Excellent Oral And Written Communication Skills, Waterfall Agile Methodologies

Note:

* Only candidates that are submitted at the rates included will be accepted.

* All candidates must be your W2 or your vendors W2, we cannot accept any candidates that are C2C to the candidate.

* We also cannot accept candidates who have more than 3 vendors – us, your agency and your vendor.

* Let all candidates know that interviews will be via video.

Description:

Senior Business Analyst PBM Claims SME

UST Global is looking for a Senior Business Analyst PBM Claims SME to work with one of the leading healthcare providers in US. The ideal candidate must possess excellent background on PBM claims area. The candidate must possess excellent written and verbal communication skills with the ability and collaborate effectively with different teams.

Responsibilities

As a Senior Business Analyst PBM Claims SME, you will
- Participate in activities related to the design, development and maintenance of the PBM business strategies and enterprise initiatives
- Work with Pharmacy Business and IT stakeholders on business requirement elicitation
- Capturing the business needs from Commercial Plan Sponsors, Medicaid and Medicare business stakeholders
- Collaborate with other business functional groups including but not limited to Formulary management, Benefit Configuration, Pricing and Networks, Membership and Enrolments, Finance and Reporting, Medical and Accumulator Groups
- Run query from data wearhouse applications to triage the reported claims and related issues.
- Manage, use and maintain business architecture models
- Facilitate and or actively participates in meetings related to the designated project s, both locally and internationally, with clients and or partners.

Requirements

- 8 + years healthcare experience
- 5+ years working experience with Pharmacy Benefit Manager PBM Pharmacy spectrum as Business Analyst with core Business team
- Excellent knowledge on Rx Accumulators and Rx claims
- Working experience with Anthem NextRxProServProPBM
- Demonstrated Working experience in Payer PBM interfaces few key entities from Pharmacy PBM spectrum:
• Accumulators
• Claim Processing
• Member Eligibility
• Benefits
- Excellent knowledge in Elicitation of Business requirements by collaborating with Business sponsors
- Efficient in translating Business Requirements into Functional and Non Functional Requirements
- Strong communication skillset who can be engaged with business stakeholders as Pharmacy domain SME
- The ability to travel to attend off site meetings with key business stakeholders
- Strong exposure to Agile and Waterfall Model and tools eg JIRA, Confluence etc
- Knowledge to write basic database queries

Location

Positions located in Mason, Ohio; Georgia and Los Angeles
 
Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 101616 while calling.
 
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