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Kodeva LLC
Technical BA – Pharmacy Benefits (PBM Expert)

Technical BA – Pharmacy Benefits (PBM Expert)

Hybrid

Hartford, United states

Mid level

Freelance

18-01-2026

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Skills

Communication SQL Data Mining Architecture

Job Specifications

Role: Technical BA – Pharmacy Benefits (PBM Expert)

Location: Hartford, CT (Hybrid)Industry: Healthcare / PBM

We are looking for a Technical Business Analyst who lives at the intersection of Clinical Logic and System Architecture. This isn't a generalist role; we need someone who understands the high stakes of Pharmacy Benefits. You will be responsible for ensuring that our technical builds align with CMS regulations, NCPDP standards, and—most importantly—patient access to medication.

The "Healthcare Expert" Responsibilities

Claims Adjudication Logic: Documenting complex rules for real-time claims processing, including coordination of benefits (COB) and real-time eligibility (RTE).
Regulatory Compliance: Ensuring all technical requirements meet HIPAA privacy standards and CMS (Medicare/Medicaid) reporting mandates.
Data Mapping (NCPDP): Leading the data mapping for NCPDP SCRIPT and Telecommunication standards to ensure seamless communication between the PBM, the switch, and the pharmacy.
Clinical Workflow Integration: Working with pharmacists and clinical leads to translate Formulary and Prior Authorization (PA) rules into technical logic that developers can build.
UAT with a Clinical Lens: Leading User Acceptance Testing to ensure that system outputs aren't just "technically correct" but clinically safe for members.

Qualifications

Domain Expertise: 5+ years in Healthcare IT, specifically within PBM or Health Insurance Payor environments.
Technical Proficiency: Strong SQL skills for data mining and a deep understanding of HL7/FHIR or EDI (834/837) transactions.
Education: A degree in Health Informatics, CS, or a related field. (Bonus if you have a clinical background).

About the Company

Kodeva is one of the fast emerging leaders in providing affordable and cutting-edge IT and Engineering services for organizations fortune 100 - Fortune 500. We have a large pool of IT personnel who carry extensive experience and expertise in mitigating complex IT challenges and integration of emerging technologies in a dynamic environment. Our services are high quality, reliable, resilient and responsive that helps to manage your operations efficiently. Our services include supreme technical support with access to specific a... Know more