Key Responsibilities
- Develop, optimize, and execute complex SQL queries to validate eligibility and related PBM data
- Perform manual validation of eligibility files before they are loaded into downstream systems
- Analyze data discrepancies, eligibility errors, and file-related issues
- Document findings clearly and report issues to the Customer EDI Team in a timely manner
- Support root cause analysis for eligibility failures or mismatches
- Ensure data accuracy, completeness, and compliance with PBM eligibility requirements
- Work closely with EDI, operations, and technical teams to resolve data issues
Qualifications
Required Skills and Qualifications
- Strong hands-on experience with SQL (complex joins, subqueries, aggregations, validations)
- Proven experience in PBM Eligibility processing and validation
- Solid understanding of eligibility file formats and data flows in PBM environments
- Experience performing manual data validation and reconciliation
- Strong analytical and problem-solving skills
- Ability to clearly communicate issues and findings to technical and business teams
Preferred Qualifications
- Prior experience working with EDI teams, especially PBM-related EDI processes
- Familiarity with eligibility file standards (e.g., 834 or PBM-specific formats)
- Experience supporting healthcare or pharmacy benefit systems
- Attention to detail and ability to work with large datasets
Soft Skills
- Strong communication and documentation skills
- Ability to work independently and manage priorities
- Collaborative mindset when working with cross-functional teams
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