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Business Analyst III (Pharmaceutical Audit)

Denver, CO, United States

Location: Indianapolis IN, Mason OH, Atlanta GA, Norfolk VA, Tampa FL, Denver CO, Los Angeles CA

Hours: M – F East coast Hours of Operation

Travel: Hybrid 1 (1-2 Days onsite per week)

Position Overview:

Responsible for handling high level pharmaceutical claim audits and reviewing claims issues from junior team to ensure claims are being resolved and reported in a timely manner.

How You Will Make an Impact:

Reviews and Audits Pharmaceutical claims processed by vendors to ensure proper compliance

Conducting Data analysis and issue resolution regularly

Acts as a resource to users of PBM software to address questions/issues

Vendor interaction and stakeholder management responsibilities

Develops project plans and identifies and coordinates resources, involving those outside the unit

Works with programming staff to ensure requirements will be incorporated into system design and testing

May provide direction and guidance to team members and serves as an expert for the team

Required Qualifications:

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications:

Pharmacy Claims Audit Strongly preferred

PBM (Pharmacy Benefit Management) Software Experience Strongly preferred

Experience working in an Agile environment strongly preferred

PBM (Pharmacy Benefit Management) Benefits experience preferred

Healthcare experience Strongly preferred

Data analysis and issue resolution experience preferred

SQL experience is preferred

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $69,120 to $124,416

Locations: California; Colorado

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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