Job Description

The Adjudication Analyst will be a part of the Customer Support Team, working cross-functionally to develop and implement solutions for platform workflows. This role focuses on PBM adjudication analytics, ensuring a robust and cost-effective solution for clients and members.

Responsibilities

• Provide technical and analytical resolution on the SmithRx adjudication platform
• Address escalation issues related to adjudicated claims and data sharing
• Troubleshoot mission-critical adjudication issues
• Analyze claims data inconsistencies and develop resolution reports
• Partner with Plan Operations and Account Management
• Collaborate with business partners and engineering to streamline processes
• Conduct User Acceptance Testing

Requirements

• Bachelor’s degree or equivalent experience preferred
• 2+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/or commercial health insurance experience
• EDI experience preferred
• Intermediate SQL (PostgreSQL) skill
• Intermediate Microsoft Excel skill
• Robust analytical and critical thinking skills
• Strong communication skills
• Self-starter mentality
• Execution-focused and solutions-oriented

Benefits

• No benefits