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Business Analyst, Data Operations

1 day, 4 hours ago
Anywhere
Full-time
Senior
Business Analyst
Data Science and Analytics
HIPAA JIRA Power BI SFTP
Apply Now
AffirmedRx

AffirmedRx

AffirmedRx is a pharmacy benefit management company dedicated to enhancing healthcare outcomes through integrity, clarity, and trust. They prioritize making pharmacy benefits easy to understand, accessible, and aligned with the best interests of employ...

Insurance
1-10
View All Jobs 5

Description

  • Administer Couchdrop SFTP connections, credentials, folder structures, schedules, and access for client and TPA file exchanges.
  • Monitor inbound and outbound eligibility and accumulator files for timeliness, format, and record-count accuracy.
  • Design, test, document, and maintain automated file workflows, monitoring, alerts, and recovery processes.
  • Reconcile pharmacy claims against TPA and medical carrier accumulator ledgers to identify and resolve member balance discrepancies.
  • Serve as the operational contact for TPAs, client managers, and patient care advocates on file and data issues.
  • Conduct issue intake and impact analysis, maintain a centralized issue-tracking dashboard, and provide proactive stakeholder updates.
  • Lead data operations projects, including TPA onboarding, file layout transitions, and automation initiatives.
  • Identify, deploy, and document AI-assisted tools for validation, discrepancy analysis, triage, and documentation while meeting security and HIPAA requirements.
  • Maintain operational documentation and identify recurring issues for automation, systemic fixes, or process improvements.

Requirements

  • Bachelor’s degree in Business, Healthcare Administration, Information Systems, or a related field, or equivalent experience.
  • 5+ years of experience as a business analyst, data operations analyst, or similar, including 3+ years in PBM, pharmacy benefits, or health plan operations.
  • Hands-on experience researching member-level claims, reversals, and adjustments in pharmacy claims adjudication platforms.
  • Experience reconciling accumulator discrepancies against TPA or medical carrier ledgers.
  • Working knowledge of eligibility and accumulator file layouts and exchange processes.
  • Experience managing healthcare SFTP environments; Couchdrop experience is strongly preferred.
  • Experience building file-transfer automations through managed platforms or scripting.
  • Experience working directly with TPAs or external partners to resolve data issues.
  • Project management experience leading cross-functional initiatives; PMP or similar certification is a plus.
  • Experience developing AI tools, LLM-based assistants, prompt designs, or AI-assisted workflow automation.
  • Understanding of HIPAA and secure PHI handling.
  • Experience using dashboard or tracking tools such as Excel, Power BI, Smartsheet, or Jira.
  • Strong analytical, organizational, written, and verbal communication skills.
  • Willingness to travel 10%–20%.

Benefits

  • Competitive compensation with health, dental, vision, and other benefits.
  • Opportunity to influence change in pharmacy benefit management and improve patient outcomes.
  • Collaborative culture focused on employee and business success.
  • Remote work environment with expectations for a professional, distraction-free workspace.

Interested in this position?

Apply directly on the company website

Apply Now

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