Ideally 10+ years experience working in PBM domain (Claims processing related).
Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.
Candidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists.
Candidate should have a good understanding of PBM Claims processing and related NCPDP standards (D.0 at least) and common business rules around Drug Utilization (ProDUR related).
College degree is preferred. Industry experience can be considered as substitute.
Candidates who have strong Clinical background e.g. Pharmacists but no BA background are welcome to apply (provided they are willing to perform BA role with inhouse training)
