Sr. Operations Analyst [Remote]

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Sr. Operations Analyst in the United States.

This role sits at the core of client integration and data operations within a pharmacy benefit management (PBM) environment, ensuring seamless data exchange between clients, TPAs, and internal systems. You will be responsible for leading complex integration projects that support eligibility, claims, and accumulator data synchronization across multiple platforms. The position requires strong technical and analytical expertise to manage file processing, troubleshoot data issues, and ensure the accuracy of automated workflows. Acting as a subject matter expert, you will collaborate closely with implementation teams, account managers, and external partners to deliver high-quality integration solutions. You will also play a key role in improving operational processes, developing best practices, and supporting system enhancements. This is a highly cross-functional and detail-oriented role where your work directly impacts data integrity and client satisfaction. It is ideal for someone who thrives in problem-solving, fast-paced operational environments.

Accountabilities:

• Lead end-to-end client integration activities, including onboarding, data exchange setup, and ongoing maintenance of EDI file processes.
• Monitor and manage automated batch file processing, ensuring accuracy in eligibility, claims, and accumulator data synchronization.
• Identify, troubleshoot, and resolve data exceptions, file issues, and system integration errors across platforms.
• Serve as a subject matter expert on PBM systems, file integration standards, and client-specific configurations.
• Conduct data analysis, reconciliation, and validation across multiple systems and counterparties.
• Collaborate with internal teams and external partners to gather requirements and ensure successful implementation of integrations.
• Support process improvement initiatives by identifying opportunities to enhance automation, efficiency, and data quality.
• Document processes, findings, and resolutions while ensuring compliance with operational standards and service levels.

Requirements:

• Bachelor’s degree or equivalent combination of education and experience.
• 5+ years of experience in operations analysis, PBM operations, or related healthcare data environments.
• Strong experience with client integrations, EDI file processing, or data operations within health plan or TPA systems.
• Solid understanding of claims processing, eligibility, and accumulator workflows.
• Proficiency in data analysis tools and environments, including Excel and SQL (e.g., SQL Server Management Studio or similar).
• Experience working with databases, file transfers, and data reconciliation processes.
• Strong analytical, troubleshooting, and critical-thinking skills.
• Excellent communication skills, with the ability to translate technical issues into clear business language.
• Strong organizational skills and ability to manage multiple priorities in a fast-paced environment.
• Familiarity with PBM platforms and healthcare data structures is highly preferred.

Benefits:

• Competitive compensation package aligned with experience.
• Comprehensive medical, dental, and vision coverage with low employee costs.
• Employer-paid life, AD&D, short-term and long-term disability insurance.
• 401(k) plan with employer match.
• Industry-leading paid time off policy.
• Mental health and wellness support resources.
• Flexible, remote-first work environment.
• Additional voluntary benefits and flexible spending accounts (FSA).

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.