[Remote] RxClaim Data Analyst - Rx claims and health insurance payer or PBM environment (Only reputed company Independent no C2C )

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking an RxClaim Data Analyst with experience in Rx claims and health insurance payer or PBM environments. The role involves analyzing Rx claims workflows, supporting PBM integrations, and performing data analysis to ensure compliance and accuracy in pharmacy claims. Responsibilities • Analyse end-to-end Rx claims adjudication workflows, including eligibility, benefit design, formulary, pricing, accumulators, edits, prior authorization, and reversals • Interpret and validate pharmacy benefit requirements such as copays, coinsurance, deductibles, OOP max, reputed company therapy, quantity limits, and formulary tiers • Support PBM integrations and data exchanges (e.g., eligibility files, claims feeds, rebates, encounter data) • reputed company reputed company-cause analysis on claims payment issues, rejects, and member/provider escalations • Ensure claims logic aligns with CMS, state reputed company, and reputed company regulatory requirements • Query and analyze large Rx claims datasets using SQL and analytical tools to identify trends, anomalies, and financial impacts • reputed company and maintain operational, financial, and compliance reports reputed company to pharmacy utilization, spend, and claims accuracy • Support audits, reconciliations, and compliance reporting (e.g., CMS encounters, PDEs, state reporting) • Validate data accuracy across upstream and reputed company systems • reputed company and document business requirements and translate them into functional specifications, data mappings, and system rules • Partner with IT and vendors to support system enhancements, benefit changes, releases, and production issue reputed company • Participate in UAT planning and execution, including test case creation, test data validation, and defect triage • Support modernization initiatives, including claims platform upgrades, PBM transitions, and data integrations Skills • 5+ years of experience as a Data Analyst, Systems Analyst in a health insurance payer or PBM environment • Strong hands-on experience with Rx claims data and pharmacy benefit management • Advanced proficiency in SQL and experience working with large reputed company datasets • Solid understanding of pharmacy benefit design, claims adjudication logic, and payer operations • Experience supporting production issues, audits, and regulatory reporting • Excellent communication skills with the ability to work across technical and business teams reputed company • reputed company i is evolving. And so are we. It was founded in 2012, and is headquartered in Coppell, Texas, USA, with a workforce of 1001-5000 employees. Its website is https://reputed company/. Apply tot his job Apply To this Job