Note: The job is a remote job and is open to candidates in USA. VytlOne is an independent integrated pharmacy solutions partner serving healthcare organizations and employer partners. The Sr. Operations Analyst implements new clients and supports ongoing client and third-party administrator EDI processing, serving as a subject matter expert and leading complex integration setup projects. The role also processes batch files, monitors data integrations, researches issues, and resolves data exceptions to maintain accurate eligibility, demographic, and claim data.
Responsibilities
- Process and support daily/weekly client batch file updates working directly with account managers, implementation teams and clients
- Conduct member and file research, file processing, manual updates, data analysis, troubleshoot and resolve integration and data quality issues
- Demonstrate subject matter expert knowledge of VytlOne’s PBM platform, application, file integration functions/standards and client specific configurations
- Demonstrate knowledge of pharmacy benefit administration, coverage eligibility, claim/deductible accumulators, and setup/configuration within VytlOne’s systems
- Handle routine work stream assignments and ensure quality, service levels, productivity and customer standards are consistently met
Skills
- This is a remote-based position within the Continental US
- Bachelor's degree or equivalent combination of education and experience
- PBM operations
- Claims processing
- Eligibility / accumulator processing
- Client integrations
- Health plan or TPA operations
- Data operations / reporting
- 5+ years of experience as an operations analyst and/or relevant pharmacy benefit management (PBM) experience
- Proven ability to serve as subject matter expert (SME) on file integration processes for new and existing clients utilizing VytlOne's systems/applications and best practices
- Proven ability to lead complex client integrations, data conversions and perform data reconciliation across systems and counterparties
- Knowledge of electronic file exchange (EDI), databases management systems (DBMS)data manipulation and analysis
- Advanced knowledge of client operations for pharmacy benefit management (PBM)integrations and capable of learning new applications/processes
- A desire to problem solve, think critically, analyze and interpret data
- A desire to develop processes and tools to more effectively manage operational tasks
- Ability to research issues and collaborate with internal/external partners though resolution
- Ability to effectively collect and document customer requirements and knowledge share
- Strong organization skills with the ability to multi-task
- Excellent verbal and written communication skills
- Advanced knowledge of personal computers, including Windows Operating Systems
- MS Office (Excel, MS Access, Word, Outlook)
- MS SQL Server Management Studios (Or other SQL querying language)
- Familiarity using AI-enabled tools for business analysis, such as data interpretation, documentation, or operational insights
Benefits
- Remote-based position within the Continental US
- A diverse and inclusive work culture that supports a flexible work model in a collaborative, innovative team-oriented environment
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
Company Overview