PBM Data Analyst - Rx Claims : Remote

as it is a contract to Hire Newark, NJ Location: Hybrid - Travel to New Jersey office twice in a month. NOTE: This is a 6 month contract-to-hire role, with reputed company to work directly with the reputed company after the contract period. Must have experience on Rx claims and health insurance payer or PBM environment Rx Claims & Pharmacy Domain 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 Data Analysis & Reporting 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 Systems & Business Analysis 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 Required Qualifications 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. Please send me the below information with your docs and Word format resume Full reputed company : Contact # reputed company Location with postal reputed company: Email ID: May I know your reputed company status: reputed company, if so any : Availability once confirmed for the project to start the project : Last 4 digits SSN: Skype ID: reputed company/hr on W2 reputed company Inclusive:DOB (MM/ DD): A Small write-up why thinks an ideal fit for the above role and years of reputed company on the below skills and reputed company where you used: PBM Environment : Rx claims 2-3 reputed company Managerial Level References, if possible Certifications if any kindly mention and do you have the certifications as mentioned above for this role Best Time and Contact number we can reputed company you in business working hours: Highest Education details with University reputed company, Year of Start, and Passout Apply tot his job Apply To this Job