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PBM Eligibility Analyst
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Job Description
- Req#: 112273
Employer Industry: Pharmacy Benefits Management
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits package including Health, Dental, Vision, Life, and 401k
- Remote work flexibility
- Engaging work environment with opportunities to collaborate with internal and external stakeholders
- Chance to play a critical role in enhancing data quality and system performance
What to Expect (Job Responsibilities):
- Process various membership enrollment changes and take ownership of problem resolution
- Maintain understanding of electronic enrollment data flow processes for complex transactions
- Investigate and resolve errors in EDI file processing, transaction failures, and data mismatches
- Provide technical support and guidance on EDI eligibility workflows to internal teams and external partners
- Compile and provide enrollment monitoring reports both internally and externally
What is Required (Qualifications):
- Minimum of 4+ years of experience in PBM eligibility management, data integration, or a similar field
- Experience working with PBM eligibility file formats such as 834, XML, and proprietary formats
- Familiarity with PBM claims adjudication processes and healthcare data standards
- Advanced proficiency in Excel, including macros, pivot tables, and complex formulas
- Working knowledge of SQL queries and experience with data mapping and transformation
How to Stand Out (Preferred Qualifications):
- Certification in project management (e.g., PMP, Six Sigma) or process improvement
- Knowledge of cloud-based EDI environments (AWS, Snowflake, etc.)
- Experience with automated testing and monitoring tools for EDI transactions
- Hands-on experience with file transmission protocols (e.g., FTP/Secure FTP, VPN)
#PharmacyBenefitsManagement #RemoteWork #CareerGrowth #DataIntegration #HealthcareStandards
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