The Plan Operations Analyst plays a key role in maintaining the integrity and efficiency of pharmacy benefit operations. By managing system configurations and validating data flows from external partners, this position ensures accurate processing of eligibility, accumulators, and claims adjudication. The analyst conducts regular audits and reconciliation activities to support both internal teams and third-party administrators.
Key Responsibilities
- Collaborate with relationship managers to address operational challenges and support ongoing projects for partner accounts
- Design and execute ad hoc reports and queries to identify and resolve data discrepancies
- Monitor inbound files from external partners to verify configuration accuracy and data consistency
- Lead cross-functional efforts to troubleshoot engineering operations and claims processing issues
- Support onboarding of new partners and client implementations by coordinating with technical teams
- Document workflows and contribute to process improvements that enhance operational efficiency
- Mentor team members and lead training on new procedures and system updates
- Act as a subject matter expert on plan design and account structure configurations
- Escalate critical issues to leadership and track resolution progress
- Work closely with technical partners to identify, report, and follow up on outstanding requests
Qualifications
Candidates must have at least four years of experience in healthcare or pharmacy analytics, with strong proficiency in Microsoft Excel—including pivot tables, VLOOKUP, HLOOKUP, and macros. Familiarity with SQL and analytics platforms such as Looker or Tableau is required. The ideal candidate is self-driven, detail-oriented, and capable of working independently in a fast-moving environment. Excellent written and verbal communication skills are essential for collaborating across departments and with external stakeholders.
A bachelor’s degree or equivalent experience is preferred. Experience with tools like Datadog, Jira, and Salesforce is a plus. The role demands a solutions-focused mindset, adaptability under pressure, and a commitment to accuracy in a technology-driven healthcare setting.
