Senior Analyst, Adjudication

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $57.3k - $82.3k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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ConnectiveRx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2009

🏥 Healthcare

💼 Consulting

📣 Marketing

💰 Private Equity Round on 2020-03

Healthcare • Consulting • Marketing

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

• Architect adjudication solutions, interpret business requirements, author technical specifications, and coordinate implementation with external adjudicators • Lead complex root-cause investigations, transaction research, and issue resolution using transaction and program-level data • Partner with internal and external stakeholders during solution design, testing, implementations, and program enhancements • Drive technical documentation, governance, process improvements, work instructions, automation opportunities, developments, and continuous improvement initiatives • Mentor Adjudication Analysts, review technical work, share knowledge, and support complex adjudication questions • Conduct adjudication training sessions for internal teams and Adjudication Analysts • Support audits and client inquiries • Review technical designs and peer work products to validate implementation accuracy and consistent solution design • Support major client implementations, conversions, product launches, and complex escalations • Recommend strategic enhancements to improve operational efficiency, governance, documentation quality, and program outcomes

🎯 Requirements

• Bachelor's degree or 6 years' of experience required • 5+ years supporting pharmaceutical affordability or claims adjudication programs • Demonstrated experience leading complex technical initiatives • Advanced knowledge of pharmaceutical affordability programs and adjudication workflows • Strong understanding of solution architecture, business rule interpretation, and client program design needs • Knowledge of NCPDP claims processing, transaction analysis, and technical documentation requirements • Understanding of governance, compliance expectations, and operational controls supporting affordability programs • Advanced analytical, troubleshooting, and root-cause analysis skills • Strong technical specification development, implementation validation, and peer review skills • Ability to mentor analysts, share knowledge, and support complex adjudication questions • Proficiency with Microsoft Office and reporting tools where applicable • Expert understanding of and ability to navigate adjudicators' claims processing system and other software as necessary • Advanced written and verbal communication skills • Ability to adapt communication to different audiences • Compliance with SOC1, SOC2, PCI, HIPAA, company/client policies, business rules, ethics, and applicable laws • Occasional travel may be required to company offices, client sites, or external adjudication vendor locations

🏖️ Benefits

• Opportunities for a bonus (or commissions) • Medical insurance • Dental insurance • Vision insurance • Life insurance • Disability insurance • 401(k) plan, with employer contributions where applicable • Flexible paid time off (PTO) policy for exempt employees, covering sick days, personal days, and vacations • Eight standard company holidays annually • Three floating holidays annually