Business Analyst, Data Operations

🕒 6 dias atrás

🐎 Kentucky – Remoto

🐎 Kentucky – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

📉 Analista de Dados

👻 Score fantasma 14%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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AffirmedRx, a Public Benefit Corporation

SiteLinkedInTodas as Vagas

11 - 50 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance

AffirmedRx é uma Corporação de Benefício Público dedicada a transformar a indústria de gestão de benefícios farmacêuticos (PBM). Focada em transparência, cuidado centrado no paciente e soluções inovadoras, a AffirmedRx visa superar as complexidades e a opacidade que tradicionalmente afligem o setor de PBM. Empoderando indivíduos e organizações, a empresa oferece clareza e suporte inabalável na navegação dos benefícios farmacêuticos. A AffirmedRx defende a integridade e a parceria, esforçando-se para oferecer uma experiência de benefícios farmacêuticos mais saudável e informada, enfrentando audaciosamente o aumento dos custos de saúde e produtos farmacêuticos.

Descrição

• Administer SFTP connections, folder structures, credentials, and user access in Couchdrop • Monitor daily eligibility and accumulator file receipt and delivery • Coordinate new SFTP setups and changes for client onboarding and TPA implementations • Maintain partner connection, file schedule, and file-handling inventories • Design, build, and maintain automated file workflows, monitoring, and alerting • Test and document automations, including failure handling and recovery • Reconcile member claims against TPA and medical carrier accumulator ledgers • Troubleshoot claim-level reversals, adjustments, file-cycle timing, and plan-year discrepancies • Partner with Data Operations colleagues to validate findings, root causes, and corrections • Serve as day-to-day operational contact for TPA partners • Coordinate file specification changes, layout updates, and testing with TPAs • Intake, categorize, track, and prioritize file-related and data issues • Conduct impact analyses and communicate findings to technical and non-technical audiences • Maintain an issue dashboard or tracking tool as a single source of truth • Provide proactive stakeholder updates through issue resolution • Identify, prototype, test, and deploy AI-assisted data operations tools in compliance with security, privacy, and HIPAA requirements • Lead data operations projects from scoping through delivery • Define project scope, milestones, owners, dependencies, plans, risks, and status reporting • Maintain documentation and identify recurring issues for automation, systemic fixes, or process improvements

🎯 Requisitos

• Bachelor’s degree in Business, Healthcare Administration, Information Systems, or a related field, or equivalent experience • 5+ years of experience as a business analyst, data operations analyst, or similar role, including at least 3 years in PBM, pharmacy benefits, or health plan operations • Hands-on experience with pharmacy claims adjudication platforms, including researching claims, reversals, and adjustments at the member level • Experience troubleshooting accumulator discrepancies by reconciling member claims against TPA or medical carrier accumulator ledgers • Working knowledge of eligibility and accumulator file layouts and exchange processes • Experience managing SFTP environments for healthcare data exchange; Couchdrop experience strongly preferred • Experience building SFTP or file-transfer automations through a managed file transfer platform or scripting • Experience working directly with TPAs or other external partners to resolve file and data issues • Demonstrated project management experience leading cross-functional projects to on-time delivery; PMP or similar certification a plus • Experience using and developing AI tools, such as LLM-based assistants, prompt design, or AI-assisted automation • Understanding of HIPAA and secure handling of protected health information (PHI) • Experience building and maintaining a dashboard or status-tracking tool, such as Excel, Power BI, Smartsheet, or Jira • Excellent written and verbal communication skills • Strong analytical skills and ability to determine issue scope and impact • Highly organized and detail-oriented; able to manage multiple issues, projects, and stakeholders • Proactive communication habits • Alignment with AffirmedRx values of trust, accountability, and innovation • Willingness to travel 10%-20%

🏖️ Benefícios

• Competitive compensation, including health, dental, vision and other benefits • Opportunity to impact industry change in the pharmacy benefits management space • Culture where people thrive • Remote work arrangement • Professional work environment focused on optimal performance and collaboration