Analyst, Adjudication

🔥 7 hours ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $48.8k - $69.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🦅 H1B Visa Sponsor

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ConnectiveRx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2009

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🌍 Social Impact

💰 Private Equity Round on 2020-03

Healthcare Insurance • Pharmaceuticals • Social Impact

ConnectiveRx is a company that provides personalized solutions in the healthcare sector, focusing on improving the patient experience and facilitating access to medications. They leverage industry expertise to offer a variety of services aimed at making healthcare more efficient and accessible. Additionally, ConnectiveRx emphasizes diversity, equity, and inclusion within their workforce, showcasing their commitment to social responsibility.

📋 Description

• Assists in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings • Respond to and resolve business rule questions or concerns escalated by internal teams or adjudicator partners, escalating complex issues as appropriate • Conduct quality control reviews on new program setups and requested updates to ensure accuracy, consistency, and adherence to established rules and standards • Access, analyze, and interpret program and adjudication data to evaluate rule functionality; investigate discrepancies, anomalies, or incorrect outcomes and document findings • Develop and maintain a working knowledge of adjudication claims engines and networks, including differences in system logic across multiple adjudicators • Works proficiently within various tools (Salesforce, ManageEngine, CRx systems) to fulfill requests • Support documentation updates and process improvements • Primarily responsible for maintaining SOPs, work instructions, job aids, tracking logs and spreadsheets • Participate in regularly scheduled adjudication calls, ad hoc meetings, and internal discussions; engage in training sessions as required to support operational objectives

🎯 Requirements

• Bachelor’s degree from 4-year college or university or equivalent experience required • Minimum 2-4 yrs of pharmacy technician/adjudication experience • Prior experience performing quality checks, operational analysis, or investigative work preferred • Knowledge of healthcare operations claims processing, pharmaceutical affordability programs, or other rules-driven operational environments • Understanding of quality control methodologies, issue investigation, and root-cause analysis • Familiarity with interpreting, applying, and questioning documented business rules • Awareness of operational standards and documentation • Intermediate skill level in Microsoft office applications • Proficient analytical and problem-solving skills with the ability to conduct independent investigations • Must conduct research by gathering information, identifying patterns, establish relationships between data points, draw logical conclusions based on data • Excellent attention to detail and accuracy in data analysis, quality checks, and documentation • Proficient ability to listen actively and effective written and verbal communications skills for conveying findings, issues, and recommendations • Ability to adapt to different audiences, ensuring that the message is clearly articulated • Detail oriented; analytical, organized, multitasking capabilities, time management skills, quick learner, ability to work accurately and collaboratively both independently and as part of a team • Must be willing to travel to CRx offices when needed as requested by supervisor

🏖️ Benefits

• Opportunities for a bonus (or commissions) • Comprehensive benefits, including medical, dental, vision, life, and disability insurance • Access to 401(k) plan with employer contributions where applicable • Flexible paid time off (PTO) policy covering sick days, personal days, and vacations • Eight standard company holidays and three floating holidays annually