Operations Analyst
About The Position
The Operations Analyst is responsible for the implementation and support and ongoing maintenance of client and third-party administrator (TPA) electronic data interchange (EDI) processing. The analyst works in operations and utilizes systems and applications for loading batch files, monitoring automated jobs, identifying file/data issues and resolving data exceptions. These processes keep medical coverage eligibility, member demographics, and claim/deductible balance accumulators in sync between VytlOne’s PBM platform and our client’s systems. Reporting to the Sr. Manager of Client Integration, the Operations Analyst will meet all service standards to ensure client satisfaction.
Requirements
- High School Diploma/G.E.D. required. Associate’s degree or equivalent combination of education and experience
- 2+ years of progressive experience in: PBM operations, Claims processing, Eligibility / accumulator processing, Client integrations, Health plan or TPA operations, Data operations / reporting
- Proven analytical, communication and organizational skills.
- 2+ years of experience as an operations analyst and/or relevant pharmacy benefit management (PBM) experience
- Strong organization skills with the ability to multi-task
- Excellent verbal and written communication skills
- Advanced knowledge of personal computers, including Windows Operating Systems, MS Office (Excel, MS Access, Word, Outlook)
- Capable of learning new applications/processes supporting client operations for pharmacy benefit management (PBM) systems
- Possess analytical aptitude and problem solving skills
- A desire to develop processes and tools to more effectively manage operational tasks
- Ability to research issues and collaborate with internal/external partners though resolution
- Ability to effectively collect and document customer requirements and knowledge share
- Knowledge of electronic file exchange (EDI) files
Responsibilities
- Process and support daily/weekly client batch file updates working directly with account managers, implementation teams and clients.
- Conduct member and file research, file processing, manual updates, data analysis, troubleshoot and resolve integration and data quality issues.
- Demonstrate knowledge of VytlOne’s PBM platform, application, file integration functions/standards and client specific configurations.
- Demonstrate knowledge of pharmacy benefit administration, coverage eligibility, claim/deductible accumulators, and setup/configuration within VytlOne’s systems.
- Handle routine work stream assignments and ensure quality, service levels, productivity and customer standards are consistently met.
- Comply with VytlOne’s Ethical Business Conduct policy and VytlOne’s Compliance Program.
- Complete required training, as assigned, within the established timeframes.
- Must demonstrate resilience and professionalism when handling complex, time‑sensitive responsibilities.
- Promote teamwork and best practices
- Maintain regular attendance in accordance with established policies.
- Perform other job-related duties as assigned.
Benefits
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
