Remote Adjudication Analyst

Summary

Join SmithRx, a rapidly growing Health-Tech company, as an Adjudication Analyst to develop and implement streamlined solutions for platform workflows, working cross-functionally with business and technology organizations.

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

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
• 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

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