Pharmacy Business Analyst III – CarelonRx

Location : Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

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

The Business Analyst III is responsible for serving as the liaison between the business, and internal and external Pharmacy and PBM partners in translating complex business needs into operational pharmacy benefit application of requirements into coding platform.

How you will make an impact:

• Analyzes complex pharmacy book of business needs to determine optimal means of meeting those account-specific needs.

• Determines specific pharmacy account business application requirements to address complex business needs.

• Develops project plans and identifies and coordinates resources, involving those outside the unit.

• Works with internal/external stakeholders to ensure requirements will be incorporated into pharmacy benefit design and testing.

• Acts as a resource to cross-functional stakeholders to address questions/issues relative to pharmacy benefit operations and execution.

• May provide direction and guidance to team members and serve as an expert for the team.

• Provide support for the development and administration of specialized pharmacy benefit functions including pharmacy benefit builds, system functionality and capability consultation, adjudication logic, and pre and postproduction auditing.

• Leads the preparation and submission of detailed updates of benefit changes to the Pharmacy Benefit Manager (PBM),

• Oversees the design and execution of user acceptance testing (UAT) of changes ensures such changes are implemented on time, and coordinates post-implementation verification that claims are processed as intended.

• Support cross-functional teams to ensure the accuracy of pharmacy claims activity and sustain pharmacy benefit integrity.

• Analyze data and summarize performance using summary statistical procedures.

• Create and publish periodic reports, as well as any necessary ad hoc reports.

• May require taking pharmacy benefits issue/escalation(s) and devising best way to develop appropriate diagnostic and/or tracking data that will translate pharmacy benefit configuration and design into integrity-driven resolution.

• Performs detailed analysis to define root cause for reported issues and facilitate issue resolution.

• Analyzing, reporting, and developing recommendations on data related to multiple, varied business metrics.

• This position supports a sensitive, high-touch book of business with strategic demands and precise execution required; and is a functionally demanding role with both technical and operational deliverable.

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 Qualifications, Skills, and Experiences:

• Healthcare experience strongly desired.

• Healthcare claims experience strongly desired.

• Pharmacy claims experience strongly desired.

• Experience in pharmacy operations, with knowledge of drugs, drug classes, and formulary implementation preferred.

• Managed Care experience preferred.

• Pharmacy Technician Certification Board (PTCB – a national pharmacy technician association) is a value-add, but not required

• Pharmacy Benefit Manager (PBM) experience highly preferred.

• SAS Enterprise Guide, Microsoft Office Suite (Excel, Word, Access, PowerPoint, Outlook, etc.) highly preferred.

• Basic SQL and Visual Basic understanding preferred.

• SQL Management Studio, Power BI, Tableau, and Teradata SQL preferred.

• Experience with relational databases and knowledge of query tools and statistical software is highly desired.

• Ability to manipulate large sets of data desired.

• Strong analytical, organizational, presentation, and problem-solving skills desired.

• Excellent written and verbal communication skills, advanced critical thinking and problem-solving skills preferred.

• Proficient to Advanced skills in: Excel/Access applications to include data manipulation and reporting analysis with complex formulas desired.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $72,576 to $124,416.

Locations: California; Colorado; District of Columbia (Washington, DC); Maryland; Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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.