Business Analytics Associate
Core
Review and resolve pharmacy inquiries related to Non-MAC pricing and appeals, ensuring compliance with state regulations and claims adjudication logic.
Role type
Associate, Pharmacy Benefit Management (PBM) compliance & data validation
Builds
Accurate pricing responses for pharmacies and plan members; compliant submissions to state regulators
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Deliverable
client delivery | dashboards & analysis
Required skills
Pharmacy Benefit Management (PBM) processes, Non-MAC appeal handling, state regulations knowledge, claims adjudication logic, RxClaim platform (AS400) proficiency
Preferred skills
Excel, Salesforce, wholesaler invoice analysis, mathematical problem-solving
Technologies
RxClaim (AS400), Medispan, Pharmacy Portal
Responsibilities
Review and resolve Non-MAC pricing inquiries; validate pricing data using trusted sources; monitor marketplace conditions and escalate issues; support contractors with training; perform IT implementation testing; respond to Department of Insurance inquiries; assist management with ad hoc tasks
Seniority
Individual Contributor, Associate level
