PBM Clinical/Benefit Testing Analyst III

PBM Clinical/Benefit Testing Analyst III (Business Analyst III)

Location: This position will work a hybrid model (1-2 days/week in office). The ideal candidate will live within 50 miles from one of our posted Elevance Health locations.

A proud member of the Elevance Health family of companies, CarelonRx (formerly IngeinoRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

The PBM Clinical/Benefit Testing Analyst III (Business Analyst III) is responsible for serving as the liaison between the business and IT in translating complex business needs into application software.

How you will make an impact:

• Understand the Pharmacy benefit setup & validating the configuration using test claims/query testing.
• Validation of Formulary, Utilization Management & Drug List setup using Test Claims/Query testing.
• Review & provide the testing timelines to be included in the project plan.
• Ensure the adherence to committed timelines.
• Identify & triage defects to closure working with business & adjudication teams.
• Coordination/collaboration with cross functional teams that are globally dispersed.
• Ensure the compliance with mandates and project implementations.
• Provide the latest status and metrics to the Test lead/project teams.
• Acts as a resource to users of the software to address questions/issues.
• May provide direction and guidance to team members and serves as an expert for the team.

Minimum Requirements:

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• 4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration strongly preferred.
• Pharmacy Benefit Management (PBM) knowledge & Clinical formulary & Utilization Management knowledge is strongly preferred.
• Experience working in Medicaid Line of Business is strongly preferred (Commercial & Medicare experience is a plus).
• Experience with Data Analysis preferred.
• Coordination/collaboration with cross functional teams preferred.
• Experience with Jira, Blue Print, Confluence, Expertise in MS Excel strongly preferred.
• Automation skills (VB Macro/C#) preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.