Regulatory Compliance 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

Regulatory Compliance Functional Business Consultant - Remote

Job Description

The Senior Functional Business Consultant serves as a subject matter expert on assigned business systems or processes, applying a high level of expertise to ensure alignment with organizational needs. This role provides strategic consultation on client and internal projects, regulatory requirements, process improvement, impact analysis, and advanced research. Responsibilities include developing documentation, driving communications, engaging in client interaction, conducting training and testing, delivering ongoing system support, and preparing reports and audits.

Responsibilities

• Advise assigned business systems or processes as a subject matter expert, defining requirements, specifications, workflows, process changes, and project management needs
• Provide leadership and consultation to internal and external partners in identifying, adopting, and embedding operational best practices and standard operating procedures
• Conduct independent research and root cause analysis to resolve complex business and technical issues
• Deliver prompt, high-quality support to ensure client and member satisfaction and respond to customer inquiries with thorough solutions
• Oversee and facilitate testing for new or enhanced systems and processes, including test plan creation, test case design, User Acceptance Testing (UAT), and Joint Cycle Testing
• Lead cross-functional partnerships with stakeholders to ensure compliance with evolving laws, regulations, and industry audit requirements
• 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

• 5 years of work experience in business analysis, project management, regulatory, and/or process improvement to include: 3 years 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

• Proven client service skills with a track record for building strong client relations
• 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
• Expert interpersonal skills necessary to drive results and deliver on commitments in a collaborative fashion
• Skilled in meeting facilitation, conflict management, and consensus building
• Ability to handle multiple projects simultaneously and ability 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, Project, PowerPoint, and Visio skills
• Ability to perform regulatory or audit research

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Preferred Qualifications

• Implementation experience
• Rx Claims system proficiency
• Previous PBM, Healthcare, or Finance experience
• Advanced experience using queries
• Regulatory, Compliance, or Audit experience
• Regulatory research experience
• Juris Doctor (J.D.) degree

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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 $81,000.00 - $138,000.00 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.