Pharmacy Benefits Management - Business Analyst
Hiring: PBM SME / Senior Business Analyst – Pharmacy Benefits Management We are looking for experienced PBM Subject Matter Experts (SMEs) / Senior Business Analysts for a remote opportunity. Key Requirements: Ideally 8+ years of experience in Pharmacy Benefits Management (PBM), particularly claims processing. Strong knowledge of First Databank (FDB) drug nomenclature . Experience with drug coverage configuration, inclusions/exclusions, Prior Authorization (PA) criteria, formularies, and Preferred Drug Lists (PDLs). Good understanding of PBM claims processing, NCPDP D.0 standards , and ProDUR. Ability to gather business requirements and translate them into functional documentation for development and QA teams. Experience creating workflows, use cases, process diagrams, and product roadmaps using MS Visio, PowerPoint, and Excel. Candidates with a strong clinical background, including pharmacists with PBM domain expertise, are also welcome. Position Details: Work Mode: Remote Experience Level: Senior BA / Manager / Individual Contributor, depending on expertise