Adjudication Analyst

Summary

Join SmithRx's growing Customer Support Team as an Adjudication Analyst! You will work cross-functionally to develop and implement streamlined solutions for the platform's workflows, focusing on PBM adjudication analytics. Responsibilities include providing technical and analytical resolution on the SmithRx adjudication platform, addressing escalation issues, troubleshooting mission-critical adjudication issues, and performing in-depth analysis of claims data. You will partner with various teams to ensure data needs are met and collaborate on process improvements. Conducting User Acceptance Testing on software solutions is also part of the role. This position requires experience in claims processing, medical billing, or related fields, along with specific skills in SQL and Excel. SmithRx offers a comprehensive benefits package.

Requirements

• At least 2+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/or commercial health insurance experience
• Intermediate skill in Microsoft Excel
• Robust analytical skills, ability to think critically about data
• 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

Responsibilities

• Serve as customer support to internal stakeholders to provide front-line technical and analytical resolution on the SmithRx adjudication platform and all of its components for (1) eligibility, (2) plan design, (3) claims adjudication and (4) accumulator data file exchange
• Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquiries submitted by our internal business partners
• Perform troubleshooting of all mission-critical adjudication issues to triage and resolve issues in a timely manner
• Perform in depth analysis of claims data inconsistencies and develop output reports detailing resolution and data validation
• Partner closely with our Plan Operations and Account Management organizations to ensure that all of their data-related needs are met
• Collaborate with business partners and engineering to create streamlined processes for customer issue resolution
• Conduct User Acceptance Testing on software solutions and enhancements

Preferred Qualifications

• Bachelor’s degree or equivalent experience
• EDI experience
• Intermediate skill in SQL (preferably PostgreSQL)
• Curiosity and excitement to learn deeply about pharmacy adjudication under the guidance of industry-leading experts

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