Analyst, Adjudication

🕒 vor 8 Tagen

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $48.800 - $69.400 / Jahr

⏰ Vollzeit

🟢 Junior

🟡 Mittelstufe

🧐 Analyst

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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ConnectiveRx

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 2009

⚕️ Krankenversicherung

💊 Pharmazie

🌍 Soziale Wirkung

💰 Private Equity Round im 2020-03

Healthcare Insurance • Pharmaceuticals • Social Impact

ConnectiveRx ist ein Unternehmen, das personalisierte Lösungen im Gesundheitswesen anbietet, mit dem Fokus auf der Verbesserung der Patientenerfahrung und der Erleichterung des Zugangs zu Medikamenten. Sie nutzen Branchenexpertise, um eine Vielzahl von Dienstleistungen zu bieten, die darauf abzielen, das Gesundheitswesen effizienter und zugänglicher zu machen. Darüber hinaus legt ConnectiveRx Wert auf Vielfalt, Chancengleichheit und Inklusion in ihrer Belegschaft und demonstriert damit ihr Engagement für soziale Verantwortung.

Beschreibung

• 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

🎯 Anforderungen

• 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

🏖️ Vorteile

• 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