Job Description :
At least 6 years working experience in Business engagements in healthcare industry, preferably in Pharmacy Benefit Manager (PBM) / Pharmacy spectrum

(2) Pharmacy Benefit Manager (PBM) / Pharmacy spectrum as Business Analyst – with core Business team
(3) More than 7 years total healthcare experience
(4) Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)
a. Subrogation Claim Processing
b. Member Eligibility
c. Product/Benefit
d. Claim Processing
e. Prior Authorization
f. Formulary
g. Consumer/Member portals & Mobility applications
h. Medicare/Medicaid, PDE, Encounter
i. Coordination of Benefits
j. NCPDP layout and EDI Rx transactions
k. Specialty Pharmacy
l. Mail order Pharmacy
(5) Excellent knowledge in Elicitation of Business requirements by collaborating with Business sponsors
(6) Efficient in translating Business Requirements into Functional and Non-Functional Requirements
(7) Strong communication skillset who can be engaged with business stakeholders as Pharmacy domain SME
(8) Experienced in User Acceptance Testing (UAT)
(9) Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc)

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