Adjudication Analyst

3 days ago

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SmithRx

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Healthcare • Pharmaceuticals • Healthcare IT • Pharmacy Benefit Management • Pharmacy Benefits Management

51 - 200

💰 $20M Series B on 2022-03

Description

•The Adjudication Analyst will operate as part of SmithRx’s growing Customer Support Team •Work cross-functionally with business and technology organizations to develop and implement streamlined solutions to platform workflows •Assist the team in designing processes to support integral PBM adjudication analytics •Provide front-line technical and analytical resolution on the SmithRx adjudication platform and its components •Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquiries •Perform troubleshooting of mission-critical adjudication issues to triage and resolve timely •Perform in depth analysis of claims data inconsistencies and develop output reports detailing resolution and data validation •Partner closely with Plan Operations and Account Management organizations •Collaborate with business partners and engineering to create streamlined processes for customer issue resolution •Conduct User Acceptance Testing on software solutions and enhancements

Requirements

•Bachelor’s degree or equivalent experience preferred •At least 2+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/or commercial health insurance experience required •EDI experience preferred •Intermediate skill in SQL (preferably PostgreSQL) preferred •Intermediate skill in Microsoft Excel required •Robust analytical skills, ability to think critically about data •Curiosity and excitement to learn deeply about pharmacy adjudication under the guidance of industry-leading experts •Strong communication skills, both in-person and written •Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments •Execution-focused ethos - you are a solutions-oriented problem solver and efficiency driven •Flexible, adaptable, and able to respond under the pressure of a fast-paced technology company

Benefits

•Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance •Flexible Spending Benefits •401(k) Retirement Savings Program •Short-term and long-term disability •Discretionary Paid Time Off •12 Paid Holidays •Wellness Benefits •Commuter Benefits •Paid Parental Leave benefits •Employee Assistance Program (EAP) •Well-stocked kitchen in office locations •Professional development and training opportunities