Senior Business Analysis Professional - Operations

The Senior Business Systems Analysis Professional designs and defines business systems based on user needs, processes, and industry requirements. This role involves developing procedures for complex challenges, assessing solution benefits, and shaping departmental strategy. Key responsibilities include leading DSNP compliance for DMR, overseeing DSNP program implementation, guiding change management, resolving POS outages, managing reason codes and product data, and serving as a UAT testing expert for DMR claims processing.

Must Have

• Lead DSNP Compliance for DMR
• Oversee DSNP Program Implementation
• Act as Change Team Lead for DMR DSNP processes
• Lead efforts to address Point-of-Sale (POS) system issues
• Manage creation and upkeep of reason codes and product details for DMR communications
• Serve as Subject Matter Expert for User Acceptance Testing (UAT) in DMR claims processing
• At least 5 years of experience in analyzing data and solving problems
• At least 5 years of experience in improving and implementing business processes
• At least 5 years of experience in DMR Claims Processing or Pharmacy Benefits Management
• At least 3 years of experience with claims or prior authorization (PA) management systems (e.g., PAHub, CGX, CAS, Macess, RxNova)
• At least 3 years of experience in User Acceptance Testing (UAT)
• Familiarity with CMS Prescription Drug Manuals used for DMR Claims Processing
• Ability to interpret and apply federal and state requirements
• Proficiency in Microsoft Office applications

Good to Have

• Project management experience
• Knowledge of pharmacy networks
• Experience using ad-hoc query tools (such as PAHub Reporting and RxNova Intel)
• Experience using data repositories for extracting and analyzing data
• Pharmacy Technician License

Perks & Benefits

• Health benefits
• Dental benefits
• 401k plan
• Tuition reimbursement plan
• Professional development reimbursement plan

The Senior Business Systems Analysis Professional is responsible for designing and defining business systems and objectives, based on a thorough understanding of user needs, business processes, and industry requirements. This role develops or updates procedures to address complex challenges, taking into account system capabilities, limitations, operational timelines, and the desired outcomes. The Senior Professional also assesses and confirms the benefits resulting from the implementation of solutions. In addition, this position begins to shape departmental strategy, makes decisions on moderately complex to complex technical issues within project components, and operates independently. The individual has the flexibility to set objectives and determine the best approaches for their assignments.

What Will You Do

This role is part of the Pharmacy Direct Member Reimbursement (DMR) Oversight team within DST Health Solutions Operations. As a vital member of our business operations and compliance initiatives, you will:

• Lead DSNP Compliance for DMR: Make sure our processes follow Dual Eligible Special Needs Plan (DSNP) regulations. You will develop and implement strategies to meet compliance requirements and update procedures as needed.
• Oversee DSNP Program Implementation: Manage the full lifecycle of DSNP programs for DMR, working with various teams to ensure projects stay on track and are completed on time.
• Guide Change Management: Act as the Change Team Lead for DMR DSNP processes, helping the organization transition smoothly to new systems and workflows.
• Resolve POS Outages: Lead efforts to address Point-of-Sale (POS) system issues that affect members. You will manage communications and coordinate with other business teams to resolve compliance concerns related to outages.
• Manage Reason Codes and Product Data: Supervise the creation and upkeep of reason codes and product details for DMR communications, ensuring accuracy and consistency with business and member standards.
• Serve as UAT Testing Expert: Act as the Subject Matter Expert for User Acceptance Testing (UAT) in DMR claims processing, checking that systems work correctly and deliver quality results.

What You Will Bring to the Table

• At least 5 years of experience in:
• Analyzing data and solving problems
• Improving and implementing business processes
• DMR Claims Processing, Pharmacy Benefits Management, or related fields
• At least 3 years of experience in:
• Working with claims or prior authorization (PA) management systems like PAHub, CGX, CAS, Macess, RxNova, etc.
• User Acceptance Testing (UAT), validating logic, and ensuring claims processing standards
• Familiarity with CMS Prescription Drug Manuals used for DMR Claims Processing, and ability to interpret and apply federal and state requirements
• Strong skills in analyzing data and improving processes, with a focus on finding root causes and developing effective solutions
• Excellent communication, teamwork, and organizational abilities, with experience working across teams, managing multiple priorities, and achieving results in a fast-paced environment
• Proficiency in Microsoft Office applications

Not Require but will Set You Apart

• Project management experience
• Knowledge of pharmacy networks
• Experience using ad-hoc query tools (such as PAHub Reporting and RxNova Intel) and data repositories for extracting and analyzing data
• Pharmacy Technician License

Unless explicitly requested or approached by SS&C Technologies, Inc. or any of its affiliated companies, the company will not accept unsolicited resumes from headhunters, recruitment agencies, or fee-based recruitment services.

SS&C offers excellent benefits including health, dental, 401k plan, tuition and professional development reimbursement plan.

SS&C Technologies is an Equal Employment Opportunity employer and does not discriminate against any applicant for employment or employee on the basis of race, color, religious creed, gender, age, marital status, sexual orientation, national origin, disability, veteran status or any other classification protected by applicable discrimination laws.