Business Analyst, Data Operations

🔥 0 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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AffirmedRx, a Public Benefit Corporation

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

AffirmedRx is a Public Benefit Corporation dedicated to transforming the pharmacy benefit management (PBM) industry. Focused on transparency, patient-centric care, and innovative solutions, AffirmedRx aims to overcome the complexities and opacity that traditionally plague the PBM sector. By empowering individuals and organizations, the company provides clarity and unwavering support in navigating pharmacy benefits. AffirmedRx stands for integrity and partnership, striving to offer a healthier and more informed pharmacy benefits experience while boldly tackling the rising costs of healthcare and pharmaceuticals.

📋 Description

• 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

🎯 Requirements

• 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%

🏖️ Benefits

• 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