高级业务系统分析专家
Senior Business Systems Analysis Professional
作为一家按营收排名领先的金融服务和医疗技术公司，SS&C 总部位于康涅狄格州温莎，业务遍及35个国家，拥有27,000多名员工。全球约20,000家金融服务和医疗保健机构，从世界最大的公司到中小型企业，都依赖 SS&C 的专业知识、规模和技术。
职位描述
你将负责的工作：
作为一名高级药房理赔专员，你将负责关键流程，确保药房现场结算（POS）的受益人协调（COB）理赔的准确性和合规性。在此职位中，你将分析复杂问题，评估多个变量，并参与制定部门战略。你在数据分析、问题解决和法规合规方面的专业知识将是推动流程改进并取得卓越成果的关键。
- 作为药房 COB 流程和理赔处理逻辑的专家，提供专业支持。
- 分析、监控并优化药房 COB 现场结算理赔的流程和理赔逻辑。
- 领导涉及流程或逻辑变更的项目，涵盖内部和外部领域。
- 创建、更新并维护报告、政策和操作手册。
- 确保符合所有联邦和州的要求。
- 参与 CMS 项目审计和内部模拟审计。
- 与内部和外部合作伙伴在跨职能项目团队中协作，识别影响、定义需求并执行端到端测试。
- 在确定任务目标和方法上具有较大的自主权。
- 作为 COB 理赔处理中用户验收测试（UAT）的专家，确保系统运行正确并交付高质量结果。
- 执行其他指派的任务。
你将带来的能力：
- 在受益人协调（COB）流程和药房理赔处理方面有实际经验。
- 熟悉用于 COB 理赔处理的 CMS 处方药手册，并能够解读和应用联邦及州的规定。
- 3-5 年的数据分析和问题解决经验，用于流程和工作流优化。
- 熟练使用 Microsoft Office 应用程序（Access、Word、Excel、PowerPoint）。
- 优秀的沟通、团队合作和组织能力，具备建立牢固关系、有效咨询并影响跨团队利益相关者的能力。
- 能够管理多项优先任务，按时完成工作。
查看英文原文
As a leading financial services and healthcare technology company based on revenue, SS&C is headquartered in Windsor, Connecticut, and has 27,000+ employees in 35 countries. Some 20,000 financial services and healthcare organizations, from the world's largest companies to small and mid-market firms, rely on SS&C for expertise, scale, and technology.
Job Description
What You Will Get To Do:
As a Senior Pharmacy Claims Professional, you will take ownership of critical processes to ensure accuracy and compliance for pharmacy point-of-sale Coordination of Benefits (COB) adjudicated claims. In this role, you will analyze complex issues, evaluate multiple variables, and contribute to shaping departmental strategy. Your expertise in data analysis, problem-solving, and regulatory compliance will be key to driving process improvements and delivering exceptional results.
- Serve as a subject matter expert for pharmacy COB processes and claims processing logic.
- Analyze, monitor, and enhance processes and adjudication logic for pharmacy COB point-of-sale claims.
- Lead projects related to process or logic changes across internal and external areas.
- Create, update, and maintain reports, policies, and procedure documents.
- Maintain compliance with all federal and state requirements.
- Participate in CMS program audits and internal mock audits.
- Collaborate with internal and external partners on cross-functional project teams to identify impacts, define requirements, and conduct end-to-end testing.
- Exercise considerable latitude in determining objectives and approaches to assignments.
- Act as the subject matter expert for User Acceptance Testing (UAT) in COB claims processing, checking that systems work correctly and deliver quality results.
- Perform other duties as assigned.
What you will Bring:
- Proven experience with Coordination of Benefits (COB) processes and pharmacy claims adjudication.
- Familiarity with CMS Prescription Drug Manuals used for COB Claims Processing, and ability to interpret and apply federal and state requirements.
- 3–5 years of experience in data analysis and problem-solving for process and workflow optimization.
- Proficiency in Microsoft Office applications (Access, Word, Excel, PowerPoint).
- Excellent communication, teamwork, and organizational skills, with proven ability to build strong relationships, consult effectively, and influence stakeholders across teams.
- Ability to manage multiple priorities, meet deadlines, and thrive in a fast-paced, dynamic environment.
- Superior attention to detail and analytical skills for identifying and resolving complex issues.
- Demonstrated accountability, adaptability, and ownership of deliverables.
Not Required But Will Set You Apart:
- Hands-on experience with project testing, including scenario building.
- Proven background in process engineering and workflow improvement.
- Working knowledge of SQL and ad-hoc query tools for data extraction and manipulation.
- Experience with pharmacy point-of-sale (POS) logic and real-time adjudication processes.
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.
Salary is determined by various factors including, but not limited to, relevant work experience, job related knowledge, skills, abilities, business needs, and geographic regions.Jersey City, NJ: Salary range for the position: 85,000 USD to 100,000 USD. NY: Salary range for the position: 85,000 USD to 100,000 USD. Colorado: Salary range for the position: 85,000 USD to 100,000 USD.Originally posted on Himalayas