Job description
Location: Remote.
Job description:
Provide business analyst support for health plan clients as they change pharmacy benefit managers.
Experience:
Pharmacy benefit, PBM and/or health plan experience. Health plan experience preferred.
Expert knowledge of pharmacy benefits, including a working understanding of benefit designs / formularies, files exchanges (eligibility, accumulators, claims) and pharmacy networks.
Responsibilities:
Analyst will support the oversight, coordination, and completion of business requirements, testing and readiness activities necessary to support client during a PBM transition.
Work closely with Client project contacts to perform activities to support the timely completion of deliverables in accordance with the PBM transition project plan and acceptance by Client.
Specific duties, by project phase, include
Discovery
Design
Build
Test
Deploy
Identify Stakeholders
Capture requirements discovered in design sessions
Review and document lessons learned
Provide insights on gaps in testing
Review and document lessons learned
Capture requirements and create PSG deliverables
Discover and facilitate use cases, test cases, user stories
Build test plans, scenarios, cases based on requirements
Review and interpret test results for accuracy
Consult on stopgap / workaround solutions
Evaluate business processes, uncover opportunities, and propose solutions
Actively participate, provide feedback, and clarify requirements
Provide feedback and clarify requirements, as needed to support build
Ensure benefit designs are adjudicating as expected
Provide command center support if contracted
Create process flows or value add documents
Review and document lessons learned
Advise on testing strategies, timelines, areas of focus and common client challenges
Ensure defect resolution and benefit intent is complete
Assess implementation risk
Assist with meetings, agenda, and parking lot / action items
Assist with alignment around change control process
Review and provide feedback on all end to end test plans
Provide insights on gaps in testing and testing advice
Discover and facilitate use cases / test cases
Review and collaborate with client/vendor on tasks included in project plans
Advise on operational process readiness (P&P)
Assist in final requirement walkthrough for approval
PSG Benefit Validation:
identify required data and determine timeline
Advise on best practice defect resolution processes with client and PBM vendors
PSG Benefit Validation:
Report testing results
Report on organization and facilitation of requirements
Review and provide feedback on all end to end test plans
PSG Benefit Validation:
begin gathering data
Assess implementation readiness
Document and share business analysis notes
Document and share business analysis notes
Document and share business analysis notes
Review and document lessons learned
Review and document lessons learned
Develop entry and exit readiness criteria
Document and share business analysis notes
Perform impact analysis
Validate client requirements against PSG requirements
Position requirements (must): Health insurance experience, pharmacy benefit management experience
Specialized areas of focus (ideally has): Expertise/experience in the creation, configuration and testing of pharmacy benefits.
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