Business Operations Technical Analyst

Pay scale information is not necessarily reflective of actual compensation that may be earned nor a promise of any specific pay for any selected candidate or employee which is always dependent on actual experience education qualifications and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems Inc. is looking for extraordinary people to join our team!

Why join MedImpact Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity high performance and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products systems and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction service cost and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Summary

Provides system technical analyst support for claims testing processes for new plan and product implementations. The overall responsibilities include development of quality assurance testing strategies developing testing specifications to validate business requirements and ensuring adherence to defined business unit policies and procedures.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Recommends and/or makes decisions regarding the development and execution of testing strategies for individual clients and general test scenarios used across broader market segments.
• Develops quality assurance testing strategies and quality testing specifications to validate business requirements.
• Reviews analyzes and evaluates business test systems and end-user needs.
• Performs process assurance functions to ensure testing requests and associated activities adhere to defined policies and procedures
• Defines and documents use requirements to assist in the development of custom test cases and develops test plans to support the requirement testing and validation phase.
• Acts as the liaison between the testing and validation end-users Implementations and IT department. Partner with Implementation and Client Team Members to support the testing and validation requests for new product and plan implementations.
• Ensures client configuration programming is complete and accurate to defined specifications. Provide necessary support to software changes as well as ensures quality on-time deliverables.
• Assists internal department with technical claims testing setup.
• Provides direct support to the department in developing specification to create innovative tools and strategies for testing the coding and supporting structure of the pharmacy benefit plans to ensure accurate claims processing.
• Provides technical support for Point of Service (POS) testing of new rates and pharmacy carrier edits to ensure accuracy and integrity of data prior to production
• Provides proactive client test plan design analysis that establishes further opportunities for ensuring the integrity of the benefit pharmacy network formulary and other edits applied to a clients configuration for claims processing.
• Develops project plans prioritize project tasks and provide status updates on project progress.
• Works with business partners to develop and execute test plans for new client implementations eligibility records and benefit group & carrier linking.
• Analyzes claims adjudication results against requirements and identifies and reports discrepancies and inaccuracies. Makes recommendations and develops solutions to enhance the accuracy of POS system changes and configuration setups.
• Determines accuracy of adjudication configurations and approves data changes from the test environment to production
• Mentor and train team members and peers
• Lead the Testing and Validation team in solving new and unexpected problems that arise during the implementation phase of the project
• Appropriately improves processes open to suggestions and experimentation interested in re-engineering only when measurable benefits can be gained.
• Determines length and difficulty of tasks and projects assigns task/people and anticipates problems or roadblocks.
• Serves as a subject matter expert for claims adjudication configurations and expected outcomes.
• Partners closely with Information Technology Data Programmers/ Analysts in development of advanced/complex programming of modifications that impact the testing environment.
• Provides recommendations for the maintenance of the claims testing environment.
• Proactively seeks out opportunities to improve claims testing processes through technology and process improvement solutions.
• Develops efficient SQL queries to research gather data and identify solutions.

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BS/BA and 3 years experience or equivalent combination of education and experience

Computer Skills

Advanced expertise is MS Office; Word Excel PowerPoint Access and Outlook. Working knowledge of Oracle SQL Visio along with working knowledge of healthcare operating systems and MedImpact file layout specifications highly preferred.

Certificates Licenses Registrations

None required.

Other Skills and Abilities

• Ability to effectively balance a high volume of work and a variety of tasks; ability to prioritize urgent issues effectively.
• Strong analytic verbal and written communication skills.
• Detail-oriented with high degree of accuracy and organizational skills.
• Able to effectively work as a team player as well as independently
• Excellent investigative problem resolution judgment and decision- making skills required.
• Excellent presentation and consultative skills working with internal and external clients at various levels in the organization.

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

• Ability to interpret a variety of instructions furnished in written oral diagram or schedule form.

Mathematical Skills

• Ability to work with mathematical concepts such as probability and statistical inference and fundamentals of plane and solid geometry and trigonometry.

• Ability to apply concepts such as fractions percentages ratios and proportions to practical situations.

Language Skills

• Ability to read analyze and interpret general business periodicals professional journals technical procedures or governmental regulations.

• Ability to effectively present information and respond to questions from groups of managers clients customers and the general public.

Competencies To perform the job successfully an individual should demonstrate the following competencies:

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger handle or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts high precarious places fumes or airborne particles toxic or caustic chemicals outdoor weather conditions risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees colleagues clients or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position may require domestic travel.

• Medical / Dental / Vision / Wellness Programs

• Paid Time Off / Company Paid Holidays

• Incentive Compensation

• 401K with Company match

• Life and Disability Insurance

• Tuition Reimbursement

• Employee Referral Bonus

To explore all that MedImpact has to offer and the greatness you can bring to our teams please submit your resume to is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego California. Our solutions and services positively influence healthcare outcomes and expenditures improving the position of our clients in the market. MedImpact offers high-value solutions to payers providers and consumers of healthcare in the U.S. and foreign markets.

To perform this job successfully the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge skill and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified.