Senior Business Analyst (Remote) - Pharmacy

Senior Business Analyst Purpose The Senior Business Analyst supports critical Medicare pharmacy business through advanced data analysis, reporting, and operational PBM oversight. The role interprets complex data to develop reports and presentations, ensures compliance with contractual and regulatory requirements, and supports quality and performance objectives across pharmacy operations. Responsibilities Pharmacy Operational & Analytical Functions: Analyze pharmacy operational data and claims activity to identify trends, risks, and improvement opportunities; monitor claims processing and review pharmacy benefit coding for accuracy and compliance; perform prescription drug event (PDE) review, correction, and retraction activities.

Medicare Regulatory & Compliance Functions: Review and analyze monthly, quarterly, and annual data related to coverage determinations, redeterminations, and grievances; track, document, and trend Medicare and PBM related issues; participate in internal and external audits and third‑party reviews, including formulary administration, improper payment, and Acumen reporting. Reporting & Decision Support: Prepare and submit routine and ad‑hoc Medicare KPI reports, including PBM performance and compliance tracking; provide analytical support and recommendations to pharmacy leadership to inform operational and strategic decisions. Communication & Stakeholder Support: Monitor member and provider communications for accuracy, timeliness, and regulatory compliance; coordinate with internal and external stakeholders; serve as point of contact for vendor performance oversight and issue resolution.

Quality & Continuous Improvement: Support quality initiatives through provider and member outreach, participation in committees, and support of member events; conduct process analysis and contribute to studies aimed at improving efficiency, quality, and compliance; adapt to shifting priorities and manage multiple concurrent initiatives. Qualifications Bachelor's Degree in Business, Information Technology, Computer Science or related field, or four additional years of relevant work experience if no bachelor's degree. Certified Pharmacy Technician (preferred). 5 years progressive experience in business analysis, systems analysis, testing or other analytical experience.

Medicare pharmacy experience. Demonstrated ability to deliver high‑quality, effective deliverables on time and contribute to cost‑effective solutions. Proven understanding of business analysis core competencies.

High‑level knowledge and understanding of business products and services. Proficient with Microsoft Office applications. Excellent written and verbal communication skills.

Ability to analyze, organize, and prioritize work while meeting multiple deadlines. Strong customer‑service orientation, able to communicate positively with internal and external customers, including demanding or challenging ones. Salary Range $71,280 - $141,570 Physical Demands The associate is primarily seated while performing the duties of the position.

Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear.

Weights up to 25 pounds are occasionally lifted. Sponsorship in the U.S. Must be eligible to work in the U.S. without sponsorship.

Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. #J-18808-Ljbffr