Pharmacy Benefit Analyst

3 days ago

Bengaluru, Karnataka, India Vidal Health Insurance Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Job Description: Pharmacy Benefit Management (PBM) System Specialist

Job Title: PBM System Specialist

Location: Bangalore work from Office

Employment Type: Full-Time

Job Summary

We are seeking a detail-oriented and analytical Pharmacy Benefit Management (PBM) System Specialist to oversee the operation, maintenance, and optimization of our pharmacy benefit management system and masters. The PBM System Specialist will ensure the systems accuracy, compliance, and alignment with market practice. This role requires a strong understanding of pharmacy coding systems, and data interoperability standards, combined with exceptional analytical and communication skills.

Key Responsibilities

  1. Code Management:

  2. Review, validate, and add new drug codes from the various sources to the master drug database.

  3. Ensure timely and accurate updates to the tariff to support claims processing and reimbursement accuracy.

  4. Clinical Review:

  5. Evaluate medical necessity, drug interactions, and contraindications to ensure safe and effective patient care.

  6. Audit and Compliance:

  7. Monitor hospital and provider submissions to identify and prevent tariff abuse, such as the use of generic codes instead of dedicated pharmacy codes.

  8. Ensure masters and system validation are in sync with regulatory requirements.

  9. Trend Analysis:

  10. Analyse drug consumption patterns and system usage trends to identify opportunities for cost savings, process improvements, and formulary optimization.

  11. Generate reports to support strategic decision-making.

  12. Tariff Updates:

  13. Conduct periodic reviews of tariff structures, incorporating geographic, market, and economic factors.

  14. Recommend and implement updates to ensure competitive and equitable pricing.

  15. FHIR Standard Support:

  16. Support the mapping and integration of the PBM system to comply with Fast Healthcare Interoperability Resources (FHIR) standards.

  17. Assist in implementing interoperable data exchange solutions to enhance system connectivity with other healthcare platforms.

  18. Data Analysis and Reporting:

  19. Perform data analysis to provide actionable insights for business and clinical stakeholders.

  20. Utilize analytics tools to support PBM system performance and operational efficiency.

Qualifications

Required:

  • Bachelor's degree in pharmacy, or MBBS doctor healthcare administration, health informatics, or a related field.
  • Strong knowledge of pharmacy benefit management systems and processes.
  • Experience with healthcare coding systems, including National Drug Codes (NDC), J-Codes, and Healthcare Common Procedure Coding System (HCPCS).
  • Exceptional analytical and problem-solving skills with a keen attention to detail.
  • Ability to thrive in a fast-paced environment while maintaining accuracy and precision.
  • Excellent communication and stakeholder management skills to collaborate with internal teams, providers, and payers.

Preferred:

  • Advanced degree or certification in pharmacy, health informatics, or a related field.
  • Prior experience in a pharmacy or healthcare setting, such as a pharmacy technician or clinical analyst role.
  • Familiarity with FHIR standards and healthcare data interoperability.
  • Proficiency in data analytics tools (e.g., Tableau, Power BI, SQL) or reporting software.
  • Knowledge of regulatory compliance in pharmacy benefit management (e.g., CMS, HIPAA).

Key Competencies

  • Analytical thinking and data interpretation.
  • Attention to detail and organizational skills.
  • Ability to manage multiple priorities and meet deadlines.

  • Hospital Pharmacy Manager

    2 weeks ago

    Bengaluru, Karnataka, India Sri Shankara Cancer Foundation Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    Role & responsibilitiesQUALIFICATION :Bachelors /Masters degree in Pharmacy (B.Pharm)/ M Pharma from an accredited institution.Valied and Active Pharmacist license with minimum Eight years of experienceStrong knowledge on latest Onco MedicinesProficiency in Pharmacy billing software (Mandatory)Polite and good communication and interpersonal skills.JOB...

  • Benefits Analyst

    2 weeks ago

    Bengaluru, Karnataka, India Point72 Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    JOB TITLEBenefits Analyst A Career with Point72's Human Resources TeamAs an HR Team, our mission is to be trusted business partners and advisors within the Point72 community, committed to driving a distinctive culture that values collaboration, innovation, and adaptive performance. We are a group of professionals that prioritize business context while...

  • Benefits Analyst

    5 days ago

    Bengaluru, Karnataka, India Infoblox Full time ₹ 6,00,000 - ₹ 12,00,000 per year

    At Infoblox, every breakthrough begins with a bold "what if."What if your ideas could ignite global innovation?What if your curiosity could redefine the future?We invite you to step into the next exciting chapter of your career journey. Bring your creativity, drive, your daring spirit, and feel what it's like to thrive on a team big enough to make an impact,...

  • Benefit Verification Specialist

    2 weeks ago

    Bengaluru, Karnataka, India 100ms Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    About 100ms100ms is building AI agents that automate complex patient access workflows in U.S. healthcare — starting with benefits verification, prior authorization, and referral intake in specialty pharmacy.We help care teams reduce delays and administrative burden so that patients can start treatment faster. Our automation platform combines deep...

  • Healthcare Business Analyst

    7 days ago

    Bengaluru, Karnataka, India Infosys Full time ₹ 6,00,000 - ₹ 18,00,000 per year

    Healthcare Business Analyst• Domain experience: Payer core – claims/Membership/provider mgmt. • Domain experience: Provider clinical/RCM, Pharmacy benefit management • Healthcare Business Analysts - with Agile/Safe-Agile Business analysis experience • Medicaid, Medicaid experienced Business Analysts • FHIR, HL7 data analyst and interoperability...

  • Benefit Verification Specialist

    2 weeks ago

    Bengaluru, Karnataka, India 100MS Full time ₹ 3,00,000 - ₹ 5,40,000

    About 100ms100ms is building AI agents that automate complex patient access workflows in U.S. healthcare — starting with benefits verification, prior authorization, and referral intake in specialty pharmacy.We help care teams reduce delays and administrative burden so that patients can start treatment faster. Our automation platform combines deep...

  • Benefits Analyst

    2 weeks ago

    Bengaluru, Karnataka, India Point72 Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    EXPERIENCEExperienced ProfessionalsLOCATIONBengaluru, IndiaFOCUSHuman CapitalBUSINESSPoint72A CAREER WITH POINT72'S HUMAN RESOURCES TEAMAs an HR Team, our mission is to be trusted business partners and advisors within the Point72 community, committed to driving a distinctive culture that values collaboration, innovation, and adaptive performance. We are a...

  • Senior Software Dev Engineer, Pharmacy

    3 days ago

    Bengaluru, Karnataka, India Amazon Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    Join Amazon Pharmacy's ambitious mission to build a next-generation Pharmacy fulfillment technology that is reshaping healthcare delivery. As a founding member of our new Bangalore team, you'll architect and develop mission-critical fulfillment technology that ensures medication safety for millions while enabling rapid delivery capabilities to scale the...

  • Senior Software Dev Engineer, Pharmacy

    3 days ago

    Bengaluru, Karnataka, India Amazon Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    Join Amazon Pharmacy's ambitious mission to build a next-generation Pharmacy fulfillment technology that is reshaping healthcare delivery. As a founding member of our new Bangalore team, you'll architect and develop mission-critical fulfillment technology that ensures medication safety for millions while enabling rapid delivery capabilities to scale the...

  • Sr. Benefits Analyst

    2 weeks ago

    Bengaluru, Karnataka, India Dexcom Inc Full time US$ 90,000 - US$ 1,20,000 per year

    Role & responsibilitiesYou oversee Workday benefits, time off and leaves for the region, including Workday configuration testing, ServiceNow knowledge bases, employee self-service tools, and collaboration with HRIT and HR OperationsYou will develop, and maintain the benefits, time off and leaves plan to meet business objectives and operational needs.You will...