Pharmacy Benefits Management SME & Analyst

- Extensive experience in Pharmacy Benefit Management (PBM) processes - In-depth knowledge of Claims Adjudication and related data processes (Eligibility, Provider, Drug, Formulary data) - Familiarity with Electronic Prescriptions and Prior Authorizations standards is a plus - Understanding of NCPDP standards and CMS regulations for state Medicaid Pharmacy programs - Knowledge of Financial Bank Drug nomenclature and its application in drug coverage design - Experience with Medispan data as an alternative to FDB is acceptable - Awareness of current industry trends and evolving standards - Preferred college degree, with industry experience considered in lieu of degree - Strong Clinical background (e.g., Pharmacists) with some Business Analyst experience welcomed - Understanding of the Software Development Life Cycle (SDLC) and requirements management - Proficiency in documenting business processes using Visio, PowerPoint, Excel, and Word - Excellent communication and writing skills - Experience with SQL queries and data models is an advantage - Collaborative team player who shares knowledge and supports others