Adjudication Analyst

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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 and ability to think critically about data.
• Curiosity to learn about pharmacy adjudication.
• Strong communication skills, both in-person and written.
• Self-starter mentality and ability to make informed decisions.
• Execution-focused ethos with a solutions-oriented approach.
• Flexible, adaptable, and able to work in a fast-paced environment.

Responsibilities:

• Serve as customer support to internal stakeholders on the SmithRx adjudication platform.
• Address planned and unplanned escalation issues related to adjudicated claims.
• Perform troubleshooting of mission-critical adjudication issues.
• Analyze claims data inconsistencies and develop output reports.
• Collaborate with Plan Operations and Account Management organizations.
• Create streamlined processes with business partners and engineering.
• Conduct User Acceptance Testing on software solutions and enhancements.