Business Systems Analyst IV, Artificial Intelligence

Exemption Status:

United States of America (Exempt)

$95,717 - $132,808 - $169,898

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Essential Duties and Responsibilities include the following. Other duties may be assigned.

1. AI/ML Solution Discovery & Requirements

• Partner with IT and business teams to identify high-impact AI/ML opportunities, such as Prior Authorization Automation (NLP for clinical review acceleration), Fraud/Waste/ Abuse Detection (anomaly detection models), Drug Recommendations (predictive analytics for formulary optimization).
• Translate business needs into technical AI/ML requirements (data, algorithms, success metrics).    
   

2. Data and Model Governance

• Define data pipelines for AI training (Prior Authorization Guideline documents, claims, EHR, pharmacy, and eligibility data).  
• Ensure compliance with HIPAA and PBM industry regulations in AI model development.  
• Implement bias detection, explainability, and model performance monitoring frameworks.  

Cross-Functional Collaboration  

• Bridge business teams and IT data science and engineering.  
• Develop ROI analyses to prioritize AI/ML initiatives based on impact and cost.  
• Lead user acceptance testing (UAT) and change management for AI integration and adoption.  
   

AI/ML Lifecycle Support

• Document use cases, feature definitions, ethical, security and compliance considerations.  
• Monitor model performance in production (accuracy, drift, business impact).  
• Optimize human-in-the-loop workflows for AI-assisted decision-making.
   

Supervisory Responsibilities

No supervisory responsibilities

                                               

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BS/BA and 6+ years’ experience or equivalent combination of education and experience, and 2 years' of SME in respective areas.

Computer Skills

• Strong SQL and Python skills (data analysis, feature engineering basics).  
• Familiarity with PBM business model (plans, programs, and practices) as well as pharmaceutical practices (nomenclature, medications.  
• AI/ML literacy (understanding of supervised/unsupervised learning, NLP, LLMs).  

Certificates, Licenses, Registrations

None Required

Other Skills and Abilities

• Regulatory knowledge: HIPAA, AI ethics frameworks (e.g., NIST AI RMF).  
• Ability to analyze complex data flows and identify root causes of issues.  
• Excellent written and verbal communications skills with emphasis on translating technical concepts to non-technical audiences and advocating for best practices across teams.
• Demonstrated ability to work collaboratively on project teams and/or matrix-managed teams.
• Ability to appropriately schedule and prioritize multiple projects to ensure timely and effective delivery of solutions.
• Results oriented and ability to juggle multiple concurrent projects with changing priorities and deadlines.
• Expertise of Agile/Scrum methodologies and experience in Scrum Master role & responsibilities.
• Experience with generative AI (e.g., prior auth automation, automated appeal messaging) preferred, but not required.

Reasoning Ability                                                    

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills                         

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position must work on-site at the San Diego Headquarters for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.  Remote work is not an option for these purposes.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  Work hours may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires no travel however attendance maybe required at various local conferences and meetings.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.