Business Analyst II - Health Insurance Exchange at Elevance Health in Mason, Ohio

Job Description:

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.


A proud member of the Elevance Health family of companies, CarelonRx (formerly lngenioRx) leverages the power of new technologies and a strong, clinical- first lens, to deliver member-centered, lasting pharmacy care.


The Business Analyst II - Health Insurance Exchange will be responsible for supporting Clinical Pharmacy Services staff with implementation & maintenance of clinical programs and formularies. Responsible for developing project plans and leading small projects to completion.



How you will make an impact:

• Acts as liaison with clinical team to coordinate timely and accurate completion of various business deliverables.


• Maintains clinical formulary/utilization management (prior authorization, step therapy & quantity limits) in web based formulary management tool, Formulary Navigator.


• Support communication of clinical program and formulary changes to members and providers as well as internal stakeholders.


• Support quality assurance processes of clinical programs and formulary strategy


• Support compliance with PBM Accreditation requirements


• Support departmental compliance with state and federal regulations.


• Conducts root cause analysis of processes and issues, identifies, and makes recommendations for improvements, and develops documentation.


• Communicate plans, status, and issues within the team, group, or project, including business members and management.

Minimum Requirements:


Requires a BS/BA degree in related field and a minimum of 2 years related operational and/or data analysis experience, experience in database structures, and standard query and reporting tools; or any combination of education and experience which would provide an equivalent background.



Preferred Skills, Capabilities, and Experiences:

• Strong Excel skills (formulas such as vlookup etc.) strongly preferred.


• PBM or pharmacy experience (e.g. pharmacy technician, Formulary Product Manager) strongly preferred.


• Experience with Health Insurance Exchange formularies preferred.


• Formulary Software tool (e.g. Formulary Navigator, RxFlex) experience strongly preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions Associates in these jobs must follow the specific policies, procedures, guidelines, etc as stated by the Government Business Division in which they are employed.


Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Apply Now