Business Analyst

Role Overview:

We are seeking an experienced Business Analyst with strong expertise in Rx claims and pharmacy domains to support our healthcare operations. The ideal candidate will analyze large datasets, identify trends and anomalies, and collaborate with stakeholders to improve business processes and system functionality.

Key Responsibilities:

• Query, analyze, and interpret large Rx claims datasets using SQL and analytical tools to identify trends, anomalies, and financial impacts.
• Document and translate business requirements into functional specifications, data mappings, and system rules.
• Partner with IT and vendors to support system enhancements, benefit changes, releases, and production issue resolution.
• Participate in User Acceptance Testing (UAT), including test case creation, data validation, and defect triage.
• Support modernization initiatives such as claims platform upgrades, PBM transitions, and data integrations.

Required Skills & Experience:

• Hands-on experience with Rx claims data and pharmacy benefit management (PBM).
• Proficiency in SQL and analytical tools for data analysis.
• Experience writing Technical Requirement Documents (TRDs).

Preferred Qualifications:

• Familiarity with Rx claims platforms (e.g., PRIME, Caremark, OptumRx).
• Knowledge of CMS Part D, Medicaid pharmacy programs, and encounter/PDE reporting.
• Strong understanding of business processes and pharmacy operations.
• Excellent communication and collaboration skills for working with IT, vendors, and business stakeholders.