Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Functional Analyst II for their Pharmacy department. This role supports pharmacy financial performance and contract compliance through analytics, monitoring, reconciliation, and validation of financial guarantees, invoices, and payments.
Responsibilities
- Partner with cross-functional teams to support audit activities and issue resolution while ensuring accuracy and compliance with organizational standards
- Analyze pharmacy financial, contract, and operational data to identify trends, variances, risks, and improvement opportunities
- Monitor, reconcile, and validate financial guarantees and performance measures for Plan-to-PBM and client arrangements
- Support calculation, validation, reconciliation, and documentation of pharmacy-related payments, including rebates, network discounts, medical rebates, and other guarantee components
- Validate invoices and payment activity in coordination with Finance and cross-functional partners to ensure accuracy, timeliness, and compliance
- Prepare reporting, analysis, and documentation for audits, compliance reviews, root cause analysis, and stakeholder requests
- Partner with analytics teams to develop insights and recommendations that improve visibility into pharmacy financial performance and contract outcomes
- Support Account Management, Pharmacy leadership and other stakeholder with reporting, analysis, issue resolution and ad-hoc requests
Skills
- Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience
- 2 years experience as a Functional Analyst OR 4 years experience in (level 2 or above) operational role
- Highly proficient in Microsoft Office and similar applications
- Ability to create graphics and report to non-technical audiences
- Self-starter and ability to collaborate in a team environment
- Excellent communication skills both written and verbal
- Ability to synthesize large complex data and analysis into actionable insights
- Apply strong critical thinking and problem-solving skills to analyze issues, data and identify solutions
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence
- Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
- Must be eligible to work in the U.S. without Sponsorship
- 7+ years experience in an analytical role preferred. Experience in pharmacy within one or more of the following areas: PBM, health care financials, medical rebates, Medicare, Medicaid and/or Commercial pharmacy operations
Benefits
- A comprehensive benefits package (subject to eligibility requirements)
- Various incentive programs/plans (subject to eligibility requirements)
- 401k contribution programs/plans (subject to eligibility requirements)
Company Overview