Sr. Operations Analyst
New
USFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- SQLData AnalysisMicrosoft Excel
Requirements
- Bachelor’s degree or equivalent combination of education and experience.
- 5+ years of experience in operations analysis, PBM operations, or related healthcare data environments.
- Strong experience with client integrations, EDI file processing, or data operations within health plan or TPA systems.
- Solid understanding of claims processing, eligibility, and accumulator workflows.
- Proficiency in data analysis tools and environments, including Excel and SQL (e.g., SQL Server Management Studio or similar).
- Experience working with databases, file transfers, and data reconciliation processes.
- Strong analytical, troubleshooting, and critical-thinking skills.
- Excellent communication skills, with the ability to translate technical issues into clear business language.
- Strong organizational skills and ability to manage multiple priorities in a fast-paced environment.
- Familiarity with PBM platforms and healthcare data structures is highly preferred.
Responsibilities
- Lead end-to-end client integration activities, including onboarding, data exchange setup, and ongoing maintenance of EDI file processes.
- Monitor and manage automated batch file processing, ensuring accuracy in eligibility, claims, and accumulator data synchronization.
- Identify, troubleshoot, and resolve data exceptions, file issues, and system integration errors across platforms.
- Serve as a subject matter expert on PBM systems, file integration standards, and client-specific configurations.
- Conduct data analysis, reconciliation, and validation across multiple systems and counterparties.
- Collaborate with internal teams and external partners to gather requirements and ensure successful implementation of integrations.
- Support process improvement initiatives by identifying opportunities to enhance automation, efficiency, and data quality.
- Document processes, findings, and resolutions while ensuring compliance with operational standards and service levels.
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