Business Analyst- PBM

Position: Business Analyst- PBMLocation: Mason, OH (Remote Till COVID)Duration: Long Term Contract Note:- We are looking for PBM domain candidates and not IT analysts. Pharmacy Benefit Management (PBM) : Business AnalystClient is looking for a Pharmacy Benefit Management (PBM) Business Analyst to work with one of the leading healthcare providers in US as part of UST's PBM Practice. The ideal candidate must possess excellent background on Pharmacy Benefit Management (PBM) business and Rx domain spectrum. ResponsibilitiesAs a Pharmacy Benefit Management (PBM) Business Analyst, you will Process the PBM claims based on business rules Engage appropriate PBM business stakeholders in reviewing business scenarios and revise the business rules as required Collaborate with other business functional groups including (but not limited to) - Membership and Enrolments, Benefit Configuration, Pricing and Networks, Formulary management,Drug Discounts, Finance and Reporting, Downstream processing areas Run query from data warehouse applications and claims processing application (s) to triage thereported claims and related issues Facilitate and/or actively participate in meetings related to the designated project/s, bothlocally and internationally, with clients and/or partners Accurately track and report claim status Support claims review and audit activities Requirements(1) At least 2 years working experience in Business engagements in healthcareindustry, preferably in Pharmacy Benefit Manager (PBM) / Pharmacy spectrum(2) Pharmacy Benefit Manager (PBM) / Pharmacy spectrum as Business Analyst - with coreBusiness team(3) More than 3 years total healthcare experience(4) Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBMspectrum)a. Subrogation Claim Processingb. Member Eligibilityc. Product/Benefitd. Claim Processinge. Prior Authorizationf. Formularyg. Consumer/Member portals & Mobility applicationsh. Medicare/Medicaid, PDE, Encounteri. Coordination of Benefitsj. NCPDP layout and EDI Rx transactionsk. Specialty Pharmacyl. Mail order Pharmacy(5) Excellent knowledge in Elicitation of Business requirements by collaborating withBusiness sponsors(6) Efficient in translating Business Requirements into Functional and Non-FunctionalRequirements(7) Strong communication skillset who can be engaged with business stakeholders asPharmacy domain SME(8) Experienced in User Acceptance Testing (UAT)(9) Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc) Good to have(10)Working experience with PBM migration with any of the leading Payers(11)Certified in Agile practices - SAFe Practitioner, Scrum Master etc(12)Certifications in Business Analysis Disclaimer: E-Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. We especially invite women, minorities, veterans, and individuals with disabilities to apply. EEO/AA/M/F/Vet/Disability.