Overview
Remote
Depends on Experience
Contract - Independent
Contract - W2
Skills
Agile
BPMN
Business Analysis
Business Systems
SQL
Rxclaim
PBM
Analytical Skill
JIRA
Health Care
Job Details
Position: - Sr. Business Analyst (PBM Domain and RxCLAIM experience)
Location: - Remote
Type: - Contract
Job Description
- Perform comprehensive business analysis including requirement elicitation, stakeholder interviews, and gap analysis.
- Create detailed Business Process Maps (BPMs) and flow diagrams to visualize current and future-state workflows.
- Work closely with solution architects, QA teams, developers, and business users to ensure proper interpretation of Business processes.
- Use SQL to query data, validate assumptions, and support data-driven decision-making.
- Leverage analytical skills to identify root causes, assess business impact, and recommend solutions.
- Collaborate with development teams; a background in software development is considered a strong advantage.
- Maintain clear communication with both technical teams and non-technical stakeholders.
Required:
- 10+ years of experience as a business system analyst in PBM domain.
- Strong knowledge of PBM processes, such as claims adjudication, benefit design, formulary management, and regulatory compliance.
- Proven experience creating process models, flow diagrams, and BPMN documentation.
- Proficient in tools such as Visio, Lucidchart, Draw.io, or similar for process mapping.
- Solid understanding of SQL with ability to run queries and perform data validation.
- Exceptional analytical and problem-solving skills; ability to draw insights from complex data sets and processes.
- Strong communication and stakeholder management skills.
Desired:
- Hands-on experience with RxCLAIM or other PBM platforms (Argus, Medispan, etc.).
- Familiarity with Agile and Scrum frameworks; experience working with JIRA, Confluence.
- Background in software development or technical project delivery.
- Experience in healthcare data formats such as NCPDP, HL7, or EDI (837/835).
Education:
- Bachelor's degree in Computer Science, Information Systems, Healthcare Administration, or a related field.
- Relevant certifications (CBAP, CCBA, Agile BA) are a plus.
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