Sr Test Analyst PBM

Elevance Health•Indianapolis, IN

4d•Hybrid

About The Position

The Senior Test Analyst PBM is responsible for serving as the liaison between the business and IT in translating complex business needs into application software. Ensures the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components. This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health.

Requirements

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Nice To Haves

Pharmacy Benefit experience & Clinical knowledge.
4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration.
Significant experience working in the Medicaid line of business is highly desired, with additional experience in Commercial or Medicare being a plus.
Proficiency in Data Analysis.
Strong communication, problem-solving, facilitation, and analytical skills.
Experience preparing and presenting testing status and metrics reports to stakeholders.
Experience collaborating within matrix team; familiarity with Agile methodologies.
Experience with test automation tools and test data management.
Experience with Jira, Confluence, Expertise in MS Excel.
Automation skills (VB Macro/C#).
Knowledge of systems capabilities and business operations.

Responsibilities

Ensure the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components.
Understand the Pharmacy benefit setup & validate the configuration to ensure the accurate setup using Claims/Query testing.
Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.
Identify, triage, and collaborate with business and adjudication teams to resolve defects efficiently and effectively.
Work closely with globally dispersed cross-functional teams to ensure successful coordination and collaboration.
Analyzes complex end user needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address complex business needs.
Develops project plans and identifies and coordinates resources, involving those outside the unit.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as a resource to users of the software to address questions/issues.
May provide direction and guidance to team members and serves as an expert for the team.