Job description

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all! We promise to do what’s right, always. Position Summary: The Business Analyst, Data Operations is the primary liaison between the Data Operations team and AffirmedRx’s business-facing teams, particularly Client Management and Patient Care Advocates, and the day-to-day operational contact for the third-party administrators (TPAs) that exchange eligibility and accumulator data with AffirmedRx. Reporting to the Manager, Data Operations, this individual owns the operational health of eligibility and accumulator file exchange: managing SFTP connections and transfers in Couchdrop, building automations that reduce manual file handling, and troubleshooting discrepancies between member claims in the pharmacy claims adjudication platform and the accumulator ledgers maintained by TPAs. When a client manager, patient care advocate, or TPA partner identifies a file or data issue, this person gathers the details, conducts impact analysis to determine scope and severity, drives the issue to resolution, and keeps every involved party informed from the moment it is reported. No one should have to ask for a status update. The role also leads data operations projects from scoping through delivery and identifies, builds, and deploys AI-assisted tools that improve the speed and accuracy of the team’s work. Excellent written and verbal communication skills are essential, since this individual routinely translates between technical data operations work, external partners, and the business teams who depend on it. What you will do: Eligibility and Accumulator File Management (SFTP): Administer SFTP connections, folder structures, credentials, and user access in Couchdrop for inbound and outbound eligibility and accumulator files across clients and TPA partners Monitor daily file receipt and delivery, confirming files arrive on schedule, in the expected layout, and with record counts consistent with prior cycles Coordinate new SFTP setups and changes for client onboarding and TPA implementations, including connection testing, key and credential exchange, and file naming conventions Maintain an accurate inventory of partner connections, file schedules, and file-handling procedures SFTP Automation: Design, build, and maintain automated file workflows, including routing, renaming, archiving, notifications, and handoffs to downstream processing, to reduce manual file handling and human error Build monitoring and alerting for late, missing, duplicate, or malformed files so issues are caught before they affect members Test and document every automation, including failure handling and recovery steps, before it goes into production Claims and Accumulator Reconciliation: Troubleshoot accumulator discrepancies by reconciling member claims in the pharmacy claims adjudication platform against TPA and medical carrier accumulator ledgers (deductible and out-of-pocket) Trace claim-level detail (reversals, adjustments, file-cycle timing, and plan-year boundaries) to identify where and why member balances diverge Partner with Data Operations team members (ETL Developer/File Management Analyst, Senior Data Operations Engineer, PBM Claims Adjudication Expert) to validate findings, confirm root cause, and verify corrections are applied on both sides TPA and Partner Relations: Serve as the day-to-day operational contact for TPA partners on eligibility and accumulator file exchange Build trusted working relationships with TPA operations and technical contacts, and lead recurring and ad hoc calls to resolve file and data issues Coordinate file specification changes, layout updates, and testing with TPAs, ensuring changes are communicated internally before go-live Track partner-side commitments and follow up until they are met Issue Intake, Impact Analysis, and Proactive Communication: Serve as the primary point of contact for client managers and patient care advocates reporting file-related or data issues Gather all relevant details needed to scope each issue (client, file type, affected dates, impacted records, and related context), then log and categorize it to support tracking, prioritization, and reporting Conduct thorough impact analyses to determine which clients, members, or files are affected, and present findings clearly to both technical and non-technical audiences Build and maintain a dashboard or similar tracking tool that serves as the single source of truth on all open issues Provide proactive, regular updates to stakeholders, especially when work begins on an issue and when it is resolved AI Tools and Development: Identify opportunities where AI can reduce manual effort in data operations, such as file validation, discrepancy analysis, issue triage, and documentation Prototype, test, and deploy AI-assisted tools and workflows using AffirmedRx-approved enterprise AI platforms, in accordance with company security, privacy, and HIPAA requirements Validate AI-generated output against source data before it is relied upon, and document how each tool works, what data it uses, and its known limitations Project Management: Lead data operations projects such as TPA onboarding, file layout transitions, and automation initiatives from scoping through delivery Define scope, milestones, owners, and dependencies; maintain project plans and report status to the Manager, Data Operations and stakeholders Identify risks and blockers early and escalate with recommended options Documentation and Process Improvement: Maintain clear documentation of issues, analyses, reconciliations, and resolutions for future reference and audit needs Identify recurring issues or themes and flag them to the Manager, Data Operations as candidates for automation, a systemic fix, or a process change Continuously refine intake, tracking, and file-handling processes to reduce friction for everyone involved What you need: Bachelor’s degree in Business, Healthcare Administration, Information Systems, or a related field, or equivalent experience 5+ years of experience as a business analyst, data operations analyst, or similar role, including at least 3 years in PBM, pharmacy benefits, or health plan operations Hands-on experience working in pharmacy claims adjudication platforms, including researching claims, reversals, and adjustments at the member level Demonstrated experience troubleshooting accumulator discrepancies by reconciling member claims against TPA or medical carrier accumulator ledgers Working knowledge of eligibility and accumulator file layouts and exchange processes Experience managing SFTP environments for healthcare data exchange; Couchdrop experience strongly preferred Experience building SFTP or file-transfer automations, whether within a managed file transfer platform or through scripting Experience working directly with TPAs or other external partners to resolve file and data issues Demonstrated project management experience leading cross-functional projects to on-time delivery; PMP or similar certification a plus Experience using and developing AI tools, such as LLM-based assistants, prompt design, or AI-assisted automation, to improve business or data workflows Understanding of HIPAA and secure handling of protected health information (PHI) Experience building and maintaining a dashboard or status-tracking tool (e.g., Excel, Power BI, Smartsheet, Jira, or similar) Excellent written and verbal communication skills, with the ability to translate clearly between technical and non-technical audiences Strong analytical skills, with demonstrated ability to break down a reported issue and determine its full scope and impact Highly organized and detail-oriented, with the ability to manage multiple open issues, projects, and stakeholders at once A proactive communicator by habit who provides status updates before being asked, not after Mission-driven, humble, and supportive; holds high standards while fostering trust with everyone involved Aligns with AffirmedRx values, promoting trust, accountability, and innovation Willingness to travel (10%-20%) What you get: To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes To work in a culture where people thrive because when OUR team thrives, OUR business thrives Competitive compensation, including health, dental, vision and other benefits Note: AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.

Requirements

Must-haves

Eligibility and Accumulator File Management (SFTP):
Administer SFTP connections, folder structures, credentials, and user access in Couchdrop for inbound and outbound eligibility and accumulator files across clients and TPA partners
Monitor daily file receipt and delivery, confirming files arrive on schedule, in the expected layout, and with record counts consistent with prior cycles
Coordinate new SFTP setups and changes for client onboarding and TPA implementations, including connection testing, key and credential exchange, and file naming conventions
Maintain an accurate inventory of partner connections, file schedules, and file-handling procedures
Design, build, and maintain automated file workflows, including routing, renaming, archiving, notifications, and handoffs to downstream processing, to reduce manual file handling and human error
Build monitoring and alerting for late, missing, duplicate, or malformed files so issues are caught before they affect members
Test and document every automation, including failure handling and recovery steps, before it goes into production
Troubleshoot accumulator discrepancies by reconciling member claims in the pharmacy claims adjudication platform against TPA and medical carrier accumulator ledgers (deductible and out-of-pocket)
Trace claim-level detail (reversals, adjustments, file-cycle timing, and plan-year boundaries) to identify where and why member balances diverge
Serve as the day-to-day operational contact for TPA partners on eligibility and accumulator file exchange
Build trusted working relationships with TPA operations and technical contacts, and lead recurring and ad hoc calls to resolve file and data issues
Coordinate file specification changes, layout updates, and testing with TPAs, ensuring changes are communicated internally before go-live
Track partner-side commitments and follow up until they are met
Issue Intake, Impact Analysis, and Proactive Communication:
Serve as the primary point of contact for client managers and patient care advocates reporting file-related or data issues
Gather all relevant details needed to scope each issue (client, file type, affected dates, impacted records, and related context), then log and categorize it to support tracking, prioritization, and reporting
Conduct thorough impact analyses to determine which clients, members, or files are affected, and present findings clearly to both technical and non-technical audiences
Build and maintain a dashboard or similar tracking tool that serves as the single source of truth on all open issues
Provide proactive, regular updates to stakeholders, especially when work begins on an issue and when it is resolved
Identify opportunities where AI can reduce manual effort in data operations, such as file validation, discrepancy analysis, issue triage, and documentation
Prototype, test, and deploy AI-assisted tools and workflows using AffirmedRx-approved enterprise AI platforms, in accordance with company security, privacy, and HIPAA requirements

Nice-to-haves

Experience managing SFTP environments for healthcare data exchange; Couchdrop experience strongly preferred
Demonstrated project management experience leading cross-functional projects to on-time delivery; PMP or similar certification a plus

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

aigollmjira

Platform: greenhouse
Effort: quick

Benefits

Benefits detected in the listing.

Dental

Vision