This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Business Analyst – Pharmacy based in the United States.
This role sits at the intersection of healthcare operations, pharmacy benefit management, and technology delivery, supporting programs that improve access and quality of care for vulnerable populations.
You will act as a key bridge between clinical experts, clients, technical teams, and operations stakeholders to translate pharmacy business needs into clear system requirements.
The position involves working on pharmacy benefit configurations, claims processing, and regulatory-driven system updates within Medicaid and Medicare environments.
You will contribute to the implementation and optimization of pharmacy payer systems, ensuring accurate benefit design and operational effectiveness.
A strong focus is placed on analyzing data, defining business rules, and validating system outputs to ensure compliance and accuracy.
You will also support testing, configuration, and continuous improvement of pharmacy programs in collaboration with cross-functional teams.
This is a mission-driven environment where your work directly contributes to improving healthcare outcomes at scale.
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Business Analyst – Pharmacy based in the United States.
This role sits at the intersection of healthcare operations, pharmacy benefit management, and technology delivery, supporting programs that improve access and quality of care for vulnerable populations.
You will act as a key bridge between clinical experts, clients, technical teams, and operations stakeholders to translate pharmacy business needs into clear system requirements.
The position involves working on pharmacy benefit configurations, claims processing, and regulatory-driven system updates within Medicaid and Medicare environments.
You will contribute to the implementation and optimization of pharmacy payer systems, ensuring accurate benefit design and operational effectiveness.
A strong focus is placed on analyzing data, defining business rules, and validating system outputs to ensure compliance and accuracy.
You will also support testing, configuration, and continuous improvement of pharmacy programs in collaboration with cross-functional teams.
This is a mission-driven environment where your work directly contributes to improving healthcare outcomes at scale.
Accountabilities:
- Support pharmacy benefit management (PBM) implementations, system configurations, and ongoing account maintenance activities.
- Translate business requirements into functional specifications for pharmacy benefit systems, including edits, audits, and utilization controls.
- Collaborate with clinicians, product experts, and technical teams to design and implement pharmacy payer solutions.
- Analyze and document business processes, identifying opportunities for optimization and operational improvement.
- Support configuration of formulary management, prior authorization rules, and PDL (Preferred Drug List) structures.
- Perform testing of pharmacy claims, including point-of-sale (POS) validation and system output verification.
- Use analytical tools such as Excel, SQL, or ALM platforms to assess data, validate requirements, and measure impact.
- Ensure requirements traceability, documentation accuracy, and validation of implemented solutions against client expectations.
- 6+ years of experience as a pharmacy business analyst, pharmacy technician, or within PBM environments.
- Strong understanding of pharmacy benefit management, claims processing, and payer system workflows.
- Experience working with Medicaid and Medicare pharmacy programs is strongly preferred.
- Knowledge of drug data sources such as FDB, Medi-Span, or Micromedex.
- Familiarity with NCPDP standards, pharmacy claims structures, and prior authorization processes.
- Strong analytical skills with experience using Excel, SQL, or similar data analysis tools.
- Ability to translate complex business needs into clear technical and operational requirements.
- Excellent communication skills with the ability to engage technical teams, clients, and stakeholders effectively.
- Strong organizational skills with the ability to manage multiple priorities independently in a fast-paced environment.
- Annual salary range of $69,400 – $99,200 depending on experience and location
- Remote work flexibility across most U.S. locations
- Comprehensive medical, dental, and vision insurance coverage
- 401(k) retirement plan with employer match
- Paid time off with a flexible vacation policy
- Educational assistance and tuition reimbursement programs
- Leadership and technical training academies for career development
- Opportunity to work on impactful healthcare programs serving vulnerable populations
- Occasional travel for client engagement and implementation support