Sr. Operations Analyst
About The Position
The Sr. Operations Analyst is responsible for the implementation of new clients and support ongoing maintenance of client and third-party administrator (TPA) electronic data interchange (EDI) processing. The senior analyst serves as a subject matter expert and leads complex integration setup projects within operations. These integrations utilize 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, Client Integration, the Sr. Operations Analyst will meet all service standards to ensure client satisfaction.
Requirements
- 5+ years of experience as an operations analyst and/or relevant pharmacy benefit management (PBM) experience
- Knowledge of electronic file exchange (EDI), databases management systems (DBMS)data manipulation and analysis
- Advanced knowledge of client operations for pharmacy benefit management (PBM)integrations and capable of learning new applications/processes
- A desire to problem solve, think critically, analyze and interpret data
- 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
- 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)
- MS SQL Server Management Studios (Or other SQL querying language)
- Familiarity using AI-enabled tools for business analysis, such as data interpretation, documentation, or operational insights
- 5+ years of progressive experience in: PBM operations, Claims processing, Eligibility / accumulator processing, Client integrations, Health plan or TPA operations, Data operations / reporting.
Responsibilities
- Serve as subject matter expert (SME) on file integration processes for new and existing clients utilizing VytlOne’s systems/applications and best practices.
- Lead complex client integrations, data conversions and perform data reconciliation across systems and counterparties.
- 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 subject matter expert 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 Maxor’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.
Benefits
- Competitive compensation
- Comprehensive health benefits package
- 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
Senior
Education Level
Associate degree
