Business Processing Systems Analyst

Summary

Join our team as a Business System Processing – Data Analyst to design, build, and maintain data pipelines for our pharmacy claims TPA operations. You will focus on AWS Glue, S3, RDS SQL Server, and Python-driven ETL processes, supporting our CPE claims processing platform. Collaborate with cross-functional teams to ensure seamless data ingestion, claims processing, and client implementations, driving process improvements. This role involves managing EHR data, prescription claims, drug pricing, and reference data. Contribute to process improvement initiatives, reviewing workflows, and optimizing data processing. Develop expertise in supporting new client implementations and troubleshooting data issues. Partner with the product team to enhance IT operational requirements, ensuring efficiency in TPA operations. You will work with various teams, contributing to our annual product roadmap. This position requires flexibility, problem-solving skills, and a positive attitude.

Requirements

• Flexible, organized, and detail-oriented with excellent critical thinking ability
• Strong written and verbal communication skills
• Exceptional presentation skills, both in-person and online

Responsibilities

• Develop and optimize AWS Glue workflows for EHR data ingestion, cleansing, and normalization
• Build Python-based ETL pipelines to process prescription claims, applying business rules for 340B eligibility and referral claims
• Manage integration of drug price files, purchase order EDI files, and reference data into RDS SQL Server
• Ensure data pipelines meet SLAs for batch processing and real-time demands
• Data file types may include: EHR files (patients, visits), EDI files for drug ordering, reference data including drug formularies, interchange files with gateways, Health exchanges or other TPA industry data partners, client invoice or other related financial information exchanges required
• Monitor and troubleshoot AWS batch processing dashboards (Glue, Step Functions)
• Provide Tier 2/3 support for the CPE platform, resolving data discrepancies, job failures, or performance issues
• Conduct periodic audits of processing chains to ensure data integrity and compliance with 340B requirements
• Collaborate with configuration teams to validate pharmacy/CE setup in CPE
• Analyze client EHR and claims data quality during new implementations, EHR conversions, or M&A activity
• Advise on eligibility models, claims logic, invoicing processes, and reporting requirements
• Support HI-Trust certification efforts by ensuring data security and audit trails
• Partner with business analysts to document operational requirements for system enhancements
• Recommend automation opportunities (e.g., reducing manual interventions in claims processing)
• Work with product teams to translate business needs into technical specifications for CPE
• Support any data infrastructure migration from old technology stacks to new, cloud-native technology stacks
• Support any process improvement or certification efforts, such as Hitrust R2, when required, through documentation or development efforts
• Manipulate large datasets to troubleshoot issues or generate ad-hoc reports for clients
• Create dashboards to track key performance indicators (KPIs) such as claims throughput, error rates, and savings

Preferred Qualifications

• Bachelor’s degree and 10+ years of data technology experience
• 3+ years of experience with AWS Glue, S3, RDS SQL Server, and Python for ETL
• Proficiency in SQL (complex joins, stored procedures, query optimization)
• Experience with healthcare data (EHR, pharmacy claims, HL7/EDI formats)
• Exposure to SQL Server performance tuning
• AWS Certified Data Engineer
• Snowflake SnowPro Core certification
• Knowledge of HI-Trust security standards
• Familiarity with 340B program regulations and TPA operations
• Understanding of pharmacy claims adjudication processes
• Excellent interpersonal skills including such areas as team spirit, problem resolution, collaboration, pitching in where needed, valuing and respecting individuals irrespective of seniority levels
• Proven track record of improving business system processing operations

Benefits

• Health plan, dental, vision, and paid time off
• Flex time
• 401k with a company match