The Computer Merchant, LTD (TCM) · 8 hours ago
PHARMACY BENEFITS MANAGEMENT PBM SME and BUSINESS ANALYST
United States
Full-time
Remote
Senior Level, Lead/Staff
$50/hr - $55/hr
10+ years expThe Computer Merchant, LTD (TCM) is seeking a Senior Business Analyst with deep expertise in Pharmacy Benefits Management (PBM). This role involves serving as a bridge between business users and technical teams, guiding the roadmap and feature enhancements for the PBM product suite.
Consumer ElectronicsHuman ResourcesInformation TechnologyStaffing Agency
Responsibilities
Provide PBM Subject Matter Expertise for both (Development and Testing team) and stakeholders (e.g. Customers)
Own responsibility for creating requirements specifications / design documents (e.g. wire-frames, decision tables) to help developers produce technical specifications
Own responsibility for configuring drug plan benefits (e.g. Covered drugs, Pricing configuration, PA requirements) using Conduent PBM system
Interact with business and clinical users to elicit and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team
Good working knowledge on creating Process workflow or Use Cases, Powerpoint slides, Wireframes, Workflows using Microsoft Visio, Analyze data using Microsoft Excel is needed to be effective at Requirements management, Translating and simplifying requirements
Document product features/requirements related documentation, prepare roadmaps (with aid of tools such as Visio, Power point)
Qualification
Required
Provide PBM Subject Matter Expertise for both (Development and Testing team) and stakeholders (e.g. Customers)
Candidate should have deep understanding of Pharmacy Benefit Management (PBM) business processes – including Claims Adjudication, Data related processes (e.g. Eligibility data, Provider data, Drug data, Formulary data, Drug Utilization reviews) and their interconnections
Deep understanding of related PBM standards from NCPDP
Candidate should have deep understanding of Financial Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists
Candidate should be well informed about current industry trends and evolving standards
Must understand Software Development Life Cycle - including requirements management
Must be able to capture requirements, document requirements and manage requirements using requirements management tools
Must be able to document business processes using a combination of tools - Visio, Powerpoint, Excel and Word formats depending on the context and synthesize requirements into user stories, decision tables or other pertinent formats
Must have excellent communication and writing skills
Must be a team player willing to share knowledge and support team members from other areas e.g. Developers and QA Testers
Experience with SQL queries and understanding Data Models is a strong plus
Own responsibility for creating requirements specifications / design documents (e.g. wire-frames, decision tables) to help developers produce technical specifications
Own responsibility for configuring drug plan benefits (e.g. Covered drugs, Pricing configuration, PA requirements) using Conduent PBM system
Interact with business and clinical users to elicit and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team
Good working knowledge on creating Process workflow or Use Cases, Powerpoint slides, Wireframes, Workflows using Microsoft Visio, Analyze data using Microsoft Excel is needed to be effective at Requirements management, Translating and simplifying requirements
Document product features/requirements related documentation, prepare roadmaps (with aid of tools such as Visio, Power point)
Preferred
Strong plus if candidate has experience with Electronic Prescriptions and Prior-Authorizations related standards
Strong plus if candidate also understands CMS regulations related to state Medicaid Pharmacy programs
College degree is preferred. Industry experience can be considered as substitute
Candidates who have strong Clinical background (e.g. Pharmacists) and some BA background are welcome to apply (provided they are willing to switch to being a full-fledged BA with inhouse training)
Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area
Benefits
Medical, dental and vision benefits
Dependent care flexible spending account
401(k) plan
Voluntary life/short term disability/whole life/term life/accident and critical illness coverage
Employee assistance program
Sick leave in accordance with regulation
Company
The Computer Merchant, LTD (TCM)
The Computer Merchant, LTD®, (TCM) is a Veteran-Owned, nationally recognized Information Technology & Software Engineering staffing and services firm.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
John Danieli
President & CEO
Recent News
2025-08-25
Company data provided by crunchbase