• Lead requirements gathering sessions with business stakeholders, SMEs, and cross-functional teams. • Translate business needs into detailed Business Requirements Documents (BRDs), Functional Requirements Documents (FRDs), user stories, process flows, and data mappings. • Analyze and document current and future-state workflows within PBM operations. • Demonstrate strong knowledge of the pharmacy claims adjudication lifecycle, including: Member eligibility validation, Formulary checks, Benefit plan design, Prior authorization, DUR (Drug Utilization Review), Copay/coinsurance calculation, Rejections and overrides. • Work closely with IT teams to support system enhancements, integrations, and defect resolution. • Participate in system design discussions and provide functional guidance to developers. • Support EDI transactions including NCPDP standards. • Create test plans, test cases, and support SIT/UAT activities. • Perform data analysis using SQL or similar tools to validate requirements and results. • Ensure compliance with regulatory requirements (CMS, HIPAA). • Identify process improvement opportunities and recommend solutions.