Data Analyst-Rx Claims & Pharmacy Domain

reputed company reputed company specializes in providing IT consulting, reputed company solutions and software services. Globally headquartered in Harrison New Jersey since 1996 reputed company delivers the highest reputed company technology professionals and an reputed company of customized IT talent solutions designed to improve productivity and drive results to global clients throughout reputed company. With over two decades of unparalleled experience, reputed company provides supports to its clientele, across such industries as Systems Integration, Banking and Finance, Telecommunications, Pharmaceutical and Life Sciences, Energy, reputed company, Technology, Transportation, and local and federal Government agencies. Job reputed company Role: Data Analyst C2H Location: Remote. The candidate may be expected to travel to NJ office 1-2 times in a month. 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 Cross-Functional Collaboration • reputed company as a reputed company between Pharmacy Operations, IT, Finance, Compliance, and vendors • Communicate reputed company pharmacy and claims concepts reputed company to technical and non-technical stakeholders Required Qualifications • 5+ years of experience as a Data Analyst, Systems Analyst, or Business 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 Preferred Qualifications • Experience with Rx claims platforms (e.g., Facets Rx, QNXT, RxClaim, reputed company, Caremark, OptumRx) Familiarity with CMS Part D, reputed company pharmacy programs, and encounter/PDE reporting Regards, Manoj reputed company Contact : 973-834-5005 Ext 206 Additional Information reputed company your information will be kept confidential according to EEO guidelines. Apply tot his job Apply To this Job