Senior Policy Development Analyst

IMH

. Lead development and implementation of health plan policies used for adjudication rules, benefit coverage, claims payment programming, and provider reimbursement schedules .

Posted 10/30/2026full-timeRemote • Utah • United StatesSenior💰 $31 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in policy development and implementation within healthcare settings, with a strong focus on claims adjudication, benefit configuration, and regulatory compliance. Proven ability to manage projects effectively while ensuring alignment with organizational goals and maintaining high standards of communication.

Highest-signal resume keywords

Policy DevelopmentClaims Adjudication SystemsProject ManagementMedical Coding ExpertiseInterpersonal Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Policy ResearchBenefit CoverageClaims Payment ProgrammingCoding ReviewBenefit DesignData AnalysisProject TrackingUtilization ManagementFormulary ManagementRegulatory Standards

Soft Skills

Organizational SkillsInterpersonal SkillsCommunication SkillsAbility to Perform Under StressProblem-Solving Skills

Tools & Technologies

Computer-Based Word ProcessingSpreadsheetsClaims Adjudication Systems

Industry Keywords

Healthcare PolicyInsurance Product KnowledgeNCPDPPrior AuthorizationStep TherapyDrug Utilization Rules

About the role

Key responsibilities & impact

Lead development and implementation of health plan policies used for adjudication rules, benefit coverage, claims payment programming, and provider reimbursement schedules
Lead policy research from initial request through analysis, recommendation to senior management, and implementation of approved policies
Develop policies aligned with organizational goals, strategies, initiatives, marketing strategies, and required clinical input
Present recommendations, answer questions about analyses and implementation impacts, and present issues based on findings
Oversee approved policy and product change implementation and coordinate implementation teams with affected management and functional areas
Provide policy-specialist support and resources to projects and teams
Maintain current knowledge of business changes, practices, policies, and benefit quoting and adjudication procedures
Oversee coding review, make coverage and benefit determinations for individual codes, and implement changes through documentation, system setup, and provider communication
Champion initiatives requiring policy changes
Participate in functional area committees to ensure consistent policy development
Assist with benefit design, member satisfaction and market research, project tracking, prioritization, and related project management activities

Requirements

What you’ll need

Four years of policy experience
Two years of experience in a medical benefits or insurance setting, or related work experience providing understanding of claims and eligibility issues, basic medical coding expertise, and insurance product knowledge
Experience managing projects requiring strong interpersonal and organizational skills, ability to perform under stress, and meet deadlines
Excellent oral, written, and interpersonal communication skills
Intermediate skills in computer-based word processing and spreadsheets
Experience with project management, policy, research, operations, analytics, pharmacy or PBM settings, claims adjudication systems, formulary management, benefit configuration, utilization management, regulatory and industry standards, and drug utilization rules are preferred
Bachelor's Degree in a business or healthcare related field is preferred
Four years of project management experience in a regulatory or insurance setting is preferred
Familiarity with NCPDP, formulary and benefit design, prior authorization, step therapy, quantity limits, and other drug utilization rules is preferred
Ability to see and read information, documents, and monitors
Ability to verbally communicate, hear, and understand spoken information
Manual dexterity for frequent computer use
Ability to stand or sit at a desk for extended periods

Benefits

Comp & perks

Generous benefits package covering programs for living healthy, happy, secure, connected, and engaged
Remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment