Required Qualifications:
-
Bachelor’s degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of education.
-
At least 4 years of Information Technology experience.
-
At least 4 years' experience with healthcare payer, preferably on Claims, Benefits, and Care Management.
Preferred Qualifications:
• At least 4 years of experience working as a Business Analyst in healthcare domain (Health Plan, Member Enrollment, Benefit/ Plan Configuration, Provider Setup, Contract Setup, Billing and Payments, E2E Claim Processing, EDI Transactions, Medicare, Medicaid, Commercial Health Plans, COB, Accumulators)
• Candidate should have atleast 5+ yrs of experience on key PBM functions like Benefit Setup, Formulary Management, Specialty Pharmacy Process, Mail Order Drug, Claims adjudication,. Clinical programs like DUR, Precert , Rebates etc
• Proficient in understanding/ analyzing/ writing SQL queries
• Knowledge of industry tools for requirement gathering, business processing modelling, defect/ CR/ Document Control
• Analytical and Communication skills
• Planning and Co-ordination skills
• Experience with project management
• Experience and desire to work in a management consulting environment that requires regular travel