Operations Analyst in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for an Operations Analyst in the United States.

This role focuses on supporting and maintaining critical electronic data interchange (EDI) processes that ensure accurate and timely synchronization of healthcare and pharmacy benefit data across client and third-party systems. You will play a key role in processing batch files, monitoring automated workflows, and resolving data discrepancies that impact eligibility, claims, and accumulator balances. Operating within a fast-paced, detail-oriented operations environment, you will collaborate closely with internal teams and external partners to ensure seamless data integration and high-quality service delivery. The position requires strong analytical ability, technical proficiency, and the capacity to troubleshoot complex data issues. You will contribute directly to the reliability and performance of pharmacy benefit management systems that support healthcare outcomes. This is a remote role where precision, accountability, and consistency are essential.

• Process and support daily and weekly client batch file updates in coordination with account managers, implementation teams, and external clients.
• Monitor automated EDI workflows, identify file and data issues, and resolve integration or processing exceptions.
• Perform data analysis, research discrepancies, and execute manual updates to ensure accurate system synchronization.
• Maintain working knowledge of PBM systems, file integration standards, and client-specific configurations.
• Ensure accuracy of member eligibility, claims data, and deductible/accumulator balances across connected systems.
• Support routine operational assignments while meeting service level, quality, and productivity standards.
• Collaborate with internal and external stakeholders to troubleshoot issues and drive timely resolution.
• Document processes, findings, and resolutions to support knowledge sharing and operational consistency.
• Participate in training and continuous improvement initiatives to enhance operational efficiency.
• Ensure compliance with organizational policies, ethical standards, and regulatory requirements.

• High school diploma or GED required; Associate’s degree or equivalent experience preferred.
• 2+ years of experience in PBM operations, claims processing, eligibility/accumulator management, or related healthcare data operations.
• Strong analytical and problem-solving skills with the ability to interpret complex data sets.
• Experience working with electronic data interchange (EDI) files or similar data integration processes.
• Proficiency in Microsoft Office Suite, especially Excel, along with general systems navigation skills.
• Strong written and verbal communication skills with attention to detail and accuracy.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong collaboration skills with the ability to work effectively across internal and external teams.
• Ability to quickly learn new systems, workflows, and technical processes.
• Strong organizational skills and commitment to operational quality and consistency.

• Fully remote work within the continental United States.
• Competitive compensation aligned with experience and responsibilities.
• Comprehensive health benefits including medical, dental, and vision coverage.
• Mental health and wellness support resources.
• 401(k) retirement plan with employer matching contributions.
• Company-paid life insurance, AD&D, short-term and long-term disability coverage.
• Flexible spending accounts and voluntary benefit options.
• Generous paid time off and holiday policies.
• Inclusive, mission-driven work environment focused on healthcare impact.
• Opportunities for professional development and process improvement involvement.