• Parsippany , NJ
  • Miscellaneous
  • Full-Time
  • 125 Janelle Blvd

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Role: PBM Claims SME
Location: Wallingford CT/ Virginia Beach, VA/ Mason, OH/ St Lois, MO/ Atlanta, GA
Duration: 12+ Months

Detailed JD:
  • More than 5 yrs. working experience with Pharmacy Benefit Manager (PBM) / Pharmacy spectrum as Business Analyst with core Business team (not looking for IT business/system analysts)
  • More than 8 years total healthcare experience
  • Working experience with
    • Anthem- NextRx/ProServ/ProPBM (First Preference)
    • CVS (Second Preference) (Second Preference)
    • Express Script (Client)/Medco
    • Prime Therapeutics
    • Any other leading PBMs MagellanRx, RxAdvance, EnviosnRx,
  • Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)
    • Claim Processing
    • Member Eligibility
  • Experience being part of PBM Ops team is added advantage
  • 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

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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