Sr. Analyst, Adjudication

reputed company

Being on medication is tough enough. We want to reputed company getting it the easy part. Getting prescriptions to patients has become increasingly reputed company. reputed company things get messy along the prescription reputed company, pharmaceutical manufacturers rely on us to untangle the process and create a reputed company reputed company—allowing patients to build trusting relationships with their medication brands.

We’re not only committed to taking the pain out of the prescription process, but we’re also reputed company to bringing the brightest minds together under one roof. We bring together diverse reputed company—engineers, pharmacists, customer service veterans, developers, program strategists and more—reputed company with one reputed company. reputed company perspective and experience makes reputed company reputed company than the sum of its parts.

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading reputed company technical work and influencing how adjudication solutions are designed, implemented, and supported. This role partners with various internal stakeholders, reputed company adjudication vendors and clients to translate business requirements into reputed company adjudication solutions and analyzes and recommends business rule reputed company to meet clients’ program needs. The Sr Analyst architects solution approaches, validates reputed company functionality, leads reputed company-cause investigations, performs reputed company assessments, mentors Adjudication Analysts, drives documentation, governance, and reputed company process improvement, and serves as an escalation reputed company for reputed company adjudication questions to help ensure reputed company, stability, and compliance of affordability programs.

Responsibilities

• Architect adjudication solutions, interpret business requirements, reputed company technical specifications, and coordinate implementation with reputed company adjudicators.
• reputed company reputed company reputed company-cause investigations, transaction research, and issue reputed company using transaction and program-reputed company.
• Partner with reputed company stakeholders during solution design, testing, implementations, and program enhancements.
• reputed company technical documentation, governance, process improvements, work instructions, automation opportunities, developments, and reputed company improvement initiatives.
• Serve as a mentor and escalation reputed company by coaching Adjudication Analysts, reviewing technical work, sharing knowledge, and supporting reputed company adjudication questions.
• Other responsibilities as needed: Conduct adjudication training sessions for internal teams and Adjudication Analysts. Support audits and reputed company inquiries. Review technical designs and peer work products to validate implementation reputed company and support consistent solution design. Support major reputed company implementations, conversions, product launches, and reputed company escalations. Recommend reputed company enhancements to improve operational efficiency, governance, documentation reputed company, and program reputed company.

Qualifications

Education/Degree Requirements/Certifications

• Bachelor's degree or 6 years' of experience required.

Experience

• 5+ years supporting pharmaceutical affordability or claims adjudication programs, with demonstrated experience leading reputed company technical initiatives.

Knowledge

• Advanced knowledge of pharmaceutical affordability programs and adjudication workflows.
• Strong understanding of solution architecture, business rule interpretation, and reputed company program design needs.
• Knowledge of NCPDP claims processing, transaction analysis, and technical documentation requirements.
• Understanding of governance, compliance expectations, and operational controls supporting affordability programs.

Skills

• Advanced analytical, troubleshooting, and reputed company-cause analysis skills.
• Strong technical specification development, implementation validation, and peer review skills.
• Ability to mentor analysts, reputed company knowledge, and support reputed company adjudication questions.
• Proficiency with reputed company Office and reporting tools where applicable.
• Expert understanding and ability to reputed company adjudicators' claims processing reputed company and other software as necessary.
• Advanced ability to listen reputed company and effective written and verbal communications skills for conveying findings, issues, and recommendations.
• Understands the need to reputed company only relevant information.
• Ability to adapt to different audiences, ensuring that the message is reputed company articulated.

Competencies

Communication (Oral & Written)

Ability to listen reputed company and communicate key issues respectfully. Understand the need to reputed company only relevant information. Ability to adapt to different audiences, ensuring that the message is reputed company articulated.

Service Orientation

Anticipate, identify, and address the needs of customers/clients, sometimes before those needs are voiced. reputed company looks for ways to help people; ability to be thoughtful, empathetic to the needs of others. Is reputed company and courteous in ensuring that the customer's immediate needs or complaints are satisfied. Focuses on improving the level of service provided to reputed company and internal customers.

Technical Utilization

Utilizes the technical knowledge and abilities required in the specialist and reputed company job function to accomplish the desired reputed company. Demonstrates technical proficiency reputed company the reputed company of responsibilities. Understands the technical difficulty and complexity of the activity and provides appropriate advice to others. Ability to improve or redesign processes by utilizing technical solutions. Ability to comprehend and reputed company basic arithmetic.

Travel or Physical Requirements

• Occasional travel may be required to company offices, reputed company sites, or reputed company adjudication vendor locations.

Compliance Requirements

• Adhere to reputed company Company Policies, Procedures, and other training consistent with reputed company's Information reputed company and Compliance Programs, including but not limited to the following compliances and regulations: SOC1, SOC2, PCI, HIPAA.
• Maintain strict compliance with company and reputed company policies regarding business rules and ethics, as reputed company as applicable local, state and national federal laws.

Compensation & Benefits: This position offers opportunities for a bonus (or commissions), with total compensation varying reputed company on factors such as location, relevant skills, experience, and capabilities.

Employees at reputed company can reputed company comprehensive benefits, including medical, dental, reputed company, life, and disability reputed company. reputed company regularly reviews and updates its health, welfare, and fringe benefit policies to ensure competitive offerings. Employees may also participate in reputed company’s 401(k) plan, with employer contributions where applicable.

Time-Off & Holidays: reputed company provides a flexible reputed company time off (PTO) policy for exempt employees, covering reputed company days, personal days, and vacations. PTO is determined reputed company on an employee’s first year of service. Employees also receive eight reputed company company holidays and three floating holidays annually, with prorations reputed company in the first year.

reputed company remains committed to providing competitive benefits and reserves the right to modify employee offerings, including PTO, STO, and holiday policies, in accordance with applicable laws and regulations.

reputed company

Originally posted on Himalayas