Operations Analyst

New

Fully remote work within the continental United States.Full-TimeMiddle

Salary not disclosed

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Job Details

High school diploma or GED required; Associate’s degree or equivalent experience preferred.
2+ years of experience in PBM operations, claims processing, eligibility/accumulator management, or related healthcare data operations.
Strong analytical and problem-solving skills with the ability to interpret complex data sets.
Experience working with electronic data interchange (EDI) files or similar data integration processes.
Proficiency in Microsoft Office Suite, especially Excel.
General systems navigation skills.
Strong written and verbal communication skills with attention to detail and accuracy.
Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
Strong collaboration skills with the ability to work effectively across internal and external teams.
Ability to quickly learn new systems, workflows, and technical processes.
Strong organizational skills and commitment to operational quality and consistency.

Process and support daily and weekly client batch file updates.
Monitor automated EDI workflows, identify file and data issues, and resolve exceptions.
Perform data analysis, research discrepancies, and execute manual updates.
Maintain working knowledge of PBM systems, file integration standards, and client configurations.
Ensure accuracy of member eligibility, claims data, and deductible/accumulator balances.
Support routine operational assignments while meeting service level, quality, and productivity standards.
Collaborate with internal and external stakeholders to troubleshoot issues.
Document processes, findings, and resolutions.
Participate in training and continuous improvement initiatives.
Ensure compliance with organizational policies and regulatory requirements.

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