Business Analyst

Company: UST Global Inc
Location: Aliso Viejo
Posted on: March 19, 2020

Job Description:

Senior Business Analyst PBM Claims SME

UST Global is looking for a Senior Business Analyst to work with one of the leading healthcare providers in US. The ideal candidate must possess excellent background on PBM Benefits and 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, 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
- Work with Benefits and Claims area for supporting PBM claims adjudication
- 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
- More than 8 years total healthcare experience
- PBM Benefits and Claims experience is must At any of the Major PBM s
- Claim processing experience
- 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
This position is based in Mason, Ohio Atlanta, GA Others

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UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Keywords: UST Global Inc, Aliso Viejo , Business Analyst, Professions , Aliso Viejo, California