Adjudication Analyst

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SmithRx

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Healthcare Insurance • SaaS • B2B

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $20M Series B on 2022-03

📋 Description

• 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

🎯 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) required • Intermediate skill in Microsoft Excel • 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 • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Time Off • 13 Paid Holidays • Wellness benefits- Spring Health, Gympass, and Headspace • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well stocked kitchen in office locations • Professional development and training opportunities