Business Analyst, Data Operations

Role overview Own the day-to-day exchange and reliability of eligibility and accumulator data between internal business teams and external administrators. The work combines secure file-transfer operations, automation, claims and balance reconciliation, project delivery, and clear communication when data issues arise. The role also seeks ways to use AI-assisted tools to make operations faster and more accurate.

Responsibilities - Administer partner SFTP connections, access, folders, schedules, credentials, and procedures; coordinate setup and changes during client or partner implementations. - Check that expected files arrive and are delivered on time, in the correct format, and with plausible record counts. - Build and maintain automated workflows for routing, renaming, archiving, notifications, and downstream handoffs; document testing, failure handling, and recovery. - Investigate missing, late, duplicate, or malformed files and assess their scope and impact before they affect members. - Reconcile claims and member balances against administrator or medical carrier ledgers, tracing reversals, adjustments, file timing, and plan-year boundaries to find causes. - Coordinate with internal specialists and external partners to verify findings, deliver fixes, track commitments, and keep stakeholders informed; lead data operations projects and develop useful AI-assisted tools.

Requirements - Experience in data operations or a similar role, including at least three years in pharmacy benefit management, pharmacy benefits, or health plan operations. - Practical experience researching member-level claims, reversals, and adjustments in a pharmacy claims adjudication system, and resolving accumulator discrepancies. - Working knowledge of eligibility and accumulator file layouts and exchange processes; experience managing healthcare SFTP environments and building file-transfer automations. - Experience working directly with third-party administrators or other external partners to resolve data issues. - Strong analytical, organizational, project management, and written and verbal communication skills; able to explain technical issues to varied audiences and provide proactive status updates. - Understanding of HIPAA and protected health information handling, plus experience with AI tools, dashboards, or status tracking; willingness to travel 10–20%.

Nice to have Couchdrop experience is preferred. A project management certification is a plus.

Benefits and work setup The listing describes remote work with a professional, low-distraction work environment, health, dental, vision, and other benefits. Compensation is described as competitive; no amount is specified.