Analyst – Adjudication
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Job Description
Adjudication Analyst supporting implementation and analysis of ConnectiveRx pharmaceutical affordability programs. Collaborating with teams to ensure operational accuracy and program integrity in a fast-paced environment.
Responsibilities:
- 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
- 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.
Benefits:
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- 401(k) plan with employer contributions
- Flexible paid time off policy
- Eight standard company holidays
- Three floating holidays annually
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