Sr. Operations Analyst

Role overview

The Senior Operations Analyst is tasked with onboarding new clients and supporting the day-to-day upkeep of electronic data interchange (EDI) activity between clients and third-party administrators. This role acts as a subject matter expert and owns complex integration projects within operations.

The work involves using systems and applications to load batch files, watch automated processes, investigate file and data issues, and correct exceptions. These activities help keep medical coverage eligibility, member demographics, and claim and deductible balance accumulators aligned between the company’s PBM platform and client systems.

This position reports to the Sr. Manager, Client Integration and is expected to consistently meet service standards that drive client satisfaction. It is a remote role based in the Continental United States.

About the organization

The company describes itself as the nation’s only independent, fully integrated total pharmacy solutions partner. Its mission is to support hospitals, health systems, health centers, and employer partners with customized pharmacy management, 340B program expertise, specialty pharmacy, and PBA/PBM solutions. The organization emphasizes integrity, collaboration, innovation, and meaningful impact on the communities it serves.

The workplace culture is centered on authenticity, teamwork, and growth. The company says it has more than 1,600 professionals across nearly every U.S. state and offers a mission-driven environment where employees can contribute to better outcomes in healthcare.

Responsibilities

• Support implementation efforts for new clients and maintain ongoing EDI processing for clients and TPAs.
• Lead advanced integration setup work and serve as the go-to expert for file integration processes.
• Manage batch file loading, automated job monitoring, troubleshooting, and correction of data exceptions.
• Perform data conversion, reconciliation, and quality checks across systems and counterparties.
• Research integration and data issues, then coordinate with internal and external teams until they are resolved.
• Collect, document, and share client requirements and operational knowledge.
• Develop more effective processes and tools to streamline operational work.
• Process daily and weekly client batch file updates in partnership with account managers, implementation teams, and clients.
• Work on member research, file processing, manual updates, and data analysis.
• Maintain consistent quality, productivity, service levels, and customer standards.
• Follow company ethical conduct expectations and compliance program requirements.
• Complete assigned training within required timeframes.
• Demonstrate resilience and professionalism while handling sensitive, time-critical responsibilities.
• Encourage teamwork and share best practices.
• Maintain regular attendance according to policy.

Requirements

• At least 5 years of experience as an operations analyst or in a related pharmacy benefit management environment.
• Proven ability to act as a subject matter expert for file integration workflows involving both new and existing clients.
• Experience leading complex client integrations and data conversions, along with reconciliation work across multiple systems.
• Working knowledge of EDI, database management systems, data manipulation, and analysis.
• Strong understanding of PBM client operations and the ability to learn new tools and workflows quickly.
• Analytical mindset with strong problem-solving and critical-thinking skills.
• Ability to build and improve processes and operational tools.
• Comfort working with internal and external partners to investigate and resolve issues.
• Ability to gather client requirements clearly and document them effectively.
• Highly organized with the ability to manage multiple tasks at once.
• Strong verbal and written communication skills.
• Advanced computer skills, including Windows, Excel, Access, Word, and Outlook.
• Experience with SQL Server Management Studio or another SQL querying tool.
• Familiarity with AI-powered tools for analysis, documentation, or operational insight is preferred.
• Bachelor’s degree or an equivalent mix of education and experience.
• 5+ years of progressive experience in PBM operations, claims processing, eligibility or accumulator processing, client integrations, health plan or TPA operations, or data operations/reporting.

Additional information

This role requires knowledge of pharmacy benefit administration, coverage eligibility, claim and deductible accumulators, and configuration within the company’s systems. The successful candidate must be able to handle routine assignments while meeting expectations for quality, service, and productivity.

The employer offers a flexible, collaborative, team-oriented culture with competitive compensation and a comprehensive benefits package.

Benefits

• Comprehensive mental health and wellbeing support
• Nationwide Blue Cross Blue Shield PPO with an employee-friendly design, including an $850 individual annual medical deductible and $25 office visit copays
• Low biweekly premiums
• Company-paid basic life and AD&D coverage
• Company-paid short-term and long-term disability insurance
• Rx, dental, vision, voluntary benefits, and FSA options
• Employer-matched 401(k) plan
• Industry-leading PTO
• Additional employee benefits and support

Work location

This is a remote position for candidates located within the Continental US.