Functional Business Consultant - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Functional Business Consultant - Remote

Job Description

The Functional Business Consultant serves as a subject matter expert for assigned business systems or processes, providing guidance on internal and client projects, regulatory requirements, and process improvements. This role leverages advanced research, impact analysis, and issue resolution to enhance business operations, while also managing documentation, communications, training, testing, audits, and ongoing system support. The position ensures compliance, strengthens client interaction, and develops reporting solutions to drive organizational efficiency and effectiveness.

Responsibilities

• Serve as subject matter expert for assigned business systems or processes, developing requirements, specifications, process flows, and supporting change management or project delivery
• Partner with internal and external stakeholders to maintain and enhance existing applications, resolving business and technical issues to improve efficiency and user experience
• Research, evaluate, and recommend improvements to processes and system functionality, applying operational best practices and aligning with business needs
• Conduct system testing, including creation of test plans and cases, execution of User Acceptance Testing (UAT), and documentation of results to ensure quality and compliance
• Collaborate across teams to monitor and ensure compliance with applicable regulations, laws, and audit requirements, while mitigating risk through proactive process improvements
• Contribute to standard operating procedures (SOPs) and documentation to support ongoing system governance and knowledge transfer
• Other duties as assigned
  
  

Minimum Qualifications

• Bachelor's degree in business administration, IT or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 2 years of work experience in business analysis, project management, regulatory, and/or process improvement to include: 1 year of functional experience in at least one of the following areas: claims, eligibility, product, benefits, implementations
  
  

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Ability to establish and maintain relationships with clients
• Knowledge of and ability to understand highly analytical pharmaceutical claims data and general understanding of medical claims data
• Ability to conduct self-learning of new processes and software to solve analytic problems
• Interpersonal skills necessary to drive results and deliver on commitments
• Skilled in meeting facilitation, conflict management, and consensus building
• Ability to handle multiple projects simultaneously and to work under pressure with strict timelines in a fast-paced work environment
• Excellent verbal and written communication skills with prior experience giving presentations
• Proficiency in Microsoft Word, Excel, PowerPoint, Project and Visio skills
• Ability to perform regulatory or audit research
  
  

Preferred Qualifications

• Claims system proficiency
• Previous PBM or healthcare experience
• Experience using queries
• Regulatory, Compliance, or Audit experience
  
  

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.