Medicare Business Analyst

A company is looking for a Business Analyst, Member Experience. Key Responsibilities Manage first level response and resolution of escalated pharmacy issues for Medicare Part D plans Analyze complex claims activities to identify unique issues and provide direction to the Pharmacy Benefit Manager Investigate enrollment, billing, and customer service issues, communicating resolutions to clients Required Qualifications 3 years of experience with Medicare Part D/Pharmacy benefit and/or PBM related to eligibility and claims adjudication Minimum of 1 year experience in pharmacy claim analysis and quality practices BA/BS degree preferred or equivalent work experience Knowledge of Medicare Part D guidelines and regulations Experience with Prior Authorization systems and compliance with CMS regulations

Apr 7, 2025 - 19:47

A company is looking for a Business Analyst, Member Experience. Key Responsibilities Manage first level response and resolution of escalated pharmacy issues for Medicare Part D plans Analyze complex claims activities to identify unique issues and provide direction to the Pharmacy Benefit Manager Investigate enrollment, billing, and customer service issues, communicating resolutions to clients Required Qualifications 3 years of experience with Medicare Part D/Pharmacy benefit and/or PBM related to eligibility and claims adjudication Minimum of 1 year experience in pharmacy claim analysis and quality practices BA/BS degree preferred or equivalent work experience Knowledge of Medicare Part D guidelines and regulations Experience with Prior Authorization systems and compliance with CMS regulations