Responsibilities

The Formulary Operations Analyst will configure, update, and maintain custom and standard formularies within the claims adjudication system, ensuring accuracy and alignment with client intent, clinical strategy, and regulatory requirements. They will troubleshoot adjudication issues, conduct detailed analysis to resolve defects, participate in client implementations by gathering formulary requirements, serve as a clinical capabilities subject matter expert, collaborate with internal teams, perform audits to validate formulary configuration accuracy, monitor claim processing, assist in analyzing and presenting data, and support client interactions. Additionally, the Analyst will contribute to special projects, process optimization, and platform enhancements, recommending and implementing improvements to ensure greater accuracy, efficiency, and scalability of formulary operations.