Business Analyst III (Pharmaceutical Claims Audit)

Job Description

Location : Indianapolis IN, Mason OH, Atlanta GA, Norfolk VA, Tampa FL

Hours : M F East coast Hours of Operation

Travel : Hybrid 1 ( 1-2 Days onsite per week)

Position Overview :

Responsible for handling high level pharmaceutical claim audits and reviewing claims issues from junior team to ensure claims are being resolved and reported in a timely manner.

How You Will Make an Impact :

Reviews and Audits Pharmaceutical claims processed by vendors to ensure proper compliance

Conducting Data analysis and issue resolution regularly

Acts as a resource to users of PBM software to address questions / issues

Vendor interaction and stakeholder management responsibilities

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

Works with programming staff to ensure requirements will be incorporated into system design and testing

May provide direction and guidance to team members and serves as an expert for the team

Required Qualifications :

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 :

Pharmacy Claims Audit Strongly preferred

PBM (Pharmacy Benefit Management) Software Experience Strongly preferred

Experience working in an Agile environment strongly preferred

PBM(Pharmacy Benefit Management) Benefits experience preferred

Healthcare experience Strongly preferred

Data analysis and issue resolution experience preferred

SQL experience is preferred

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

Requirements include but are not limited to more stringent and frequent background checks and / or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.

Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Job Level :

Non-Management Exempt

Workshift :

1st Shift (United States of America)

Job Family : BSP >

BSP >

Business Support

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 for assistance.