17 days old

Senior IT Adjudication Analyst Pharmacy

Magellan Health
Rancho Cordova, CA 95670
  • Job Code
This position will analyze, evaluate and design/redesign business, IT or operational processes using scientific approaches such as Critical Thinking, Design Thinking and structured systems analysis and design. Provide requirements and testing leadership for the Medi-Cal pharmacy claims adjudication rules engine managed by an IT Service Owner. Drive requirements definition. Oversee detailed design and definition of acceptance criteria to ensure high quality deliverables. Drive usability and quality of the software developed within the area. Ensure integrity of the system is maintained despite the speed of changes. Be a hands-on analyst who can define user stories and acceptance criteria, assist with problem solving, root cause analysis, trouble shooting and coaching of junior it analysts on the team. Develop relationships with senior stakeholders across partner teams, addressing concerns and removing roadblocks to drive projects forward. Work closely with stakeholders to make design decision throughout the development. Is focused on achieving business goals and is vigilant about quality in every phase of the development process.
  • Focus on achieving business goals aligned to government client policy.
  • 5+ years experience in healthcare payorclaims business rules with preference toward pharmacy claims payment business rules and policies.
  • Partners with peers and clientto deliver identified system improvements.
  • Manage the deployment of business requirements through reliable business system configuration updates to enterprise applications.
  • Gather requirements and collaborate on design and definition of acceptance criteria.
  • Responsible for planning resources and tools to deliver against that roadmap.
  • Drive requirements definition, design, unit testing, and integration. Oversee detailed designs, and test plan reviews to ensure high quality deliverables.
  • Work through and document issues andproblemsto resolution.
  • Work closely with stakeholders to provide status, iterative releases, and make design decision throughout the development.
  • Engage, motivate and manage individual contributors.
  • Develop strong relationships with client andstakeholders acrossteams, addressing concerns and removing roadblocks to drive projects forward.

Other Job Requirements


  • Experience in Health care, PBM or insurance industries.
  • Experience with a variety of problem solving techniques.
  • Experience working with industry standard claims, billing or EHR systems.
  • 10+ years of related experience including experience working with Agile Methods. Experience moving across different departments within IT to gain a broader perspective of the business/industry.
  • Building strong, successful, long-term partnerships.
  • Produce actionable, results-oriented strategies to solve complex and open-ended business problems.
  • Experience performing implementation reviews.
  • Ensure prompt and proper support of resolution of technical challenges.
  • Thought leader on process improvement methodologies.
  • Use creative problem-solving approach and strong analytical skills, combined with a strong sense of ownership, and a proactive can-do attitude.
  • Excellent communication and project management skills, with a track record of handling multiple customers and streams of work.
  • Take responsibility for ensuring success of all implementations.
  • Ability to help team meet tight deadlines and prioritize workloads.

General Job Information

Work Experience

Bachelors: Computer and Information Science

License and Certifications - Required

License and Certifications - Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

Posted: 2020-10-04 Expires: 2020-11-02
Sponsored by:
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Sponsored by:
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Senior IT Adjudication Analyst Pharmacy

Magellan Health
Rancho Cordova, CA 95670

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