Ideally 10+ years experience working in PBM domain (Claims processing related).
Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.
Candidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists.
Candidate should have a good understanding of PBM Claims processing and related NCPDP standards (D.0 at least) and common business rules around Drug Utilization (ProDUR related).
College degree is preferred. Industry experience can be considered as substitute.
Candidates who have strong Clinical background e.g. Pharmacists but no BA background are welcome to apply (provided they are willing to perform BA role with inhouse training)
Numbers & Facts
Location
Edison, NJ (Remote)
Skills
Business Analysisunmatched
Claims Processingunmatched
Compensation and Benefitsunmatched
Drug Designunmatched
Formularyunmatched
Pharmacyunmatched
Preferred Drug Listunmatched
🎯
Be found by employers
5,500+ employers search our resume database daily. Add yours to get found by recruiters looking for candidates like you.
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.