Kodeva LLC · 3 hours ago
Technical BA – Pharmacy Benefits (PBM Expert)
Hartford, CT
Contract
Hybrid
Senior Level
5+ years expKodeva LLC is seeking a Technical Business Analyst who specializes in Pharmacy Benefits. The role involves ensuring technical builds align with CMS regulations and NCPDP standards while facilitating patient access to medication through various responsibilities including claims adjudication logic and regulatory compliance.
Corporate TrainingHuman ResourcesInformation TechnologyStaffing Agency
Responsibilities
Claims Adjudication Logic: Documenting complex rules for real-time claims processing, including coordination of benefits (COB) and real-time eligibility (RTE)
Regulatory Compliance: Ensuring all technical requirements meet HIPAA privacy standards and CMS (Medicare/Medicaid) reporting mandates
Data Mapping (NCPDP): Leading the data mapping for NCPDP SCRIPT and Telecommunication standards to ensure seamless communication between the PBM, the switch, and the pharmacy
Clinical Workflow Integration: Working with pharmacists and clinical leads to translate Formulary and Prior Authorization (PA) rules into technical logic that developers can build
UAT with a Clinical Lens: Leading User Acceptance Testing to ensure that system outputs aren't just "technically correct" but clinically safe for members
Qualification
Required
5+ years in Healthcare IT, specifically within PBM or Health Insurance Payor environments
Strong SQL skills for data mining
Deep understanding of HL7/FHIR or EDI (834/837) transactions
A degree in Health Informatics, CS, or a related field
Preferred
Bonus if you have a clinical background
Company
Kodeva LLC
Kodeva is one of the fast emerging leaders in providing affordable and cutting-edge IT and Engineering services for organizations fortune 100 - Fortune 500.
51-200 employees
H1B Sponsorship
Kodeva LLC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (7)
2024 (5)
2023 (4)
2022 (9)
2021 (5)
2020 (5)
Funding
Current Stage
Growth StageCompany data provided by crunchbase