• Analyst, Adjudication

    PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)


    Overview

     

    The Adjudication Analyst is responsible for various operational aspects of the implementation, support, analysis, and quality assurance of ConnectiveRx’s pharmaceutical affordability (copay) programs. The candidate will be accountable for program set-ups and maintenance and will participate in issue resolution and quality checks. This position calls for an analytical, detail-oriented person who works well independently and as part of a team. The candidate must be motivated by a fast-paced environment and be proficient at problem-solving.

    Responsibilities

    + Assists in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings

    + Is primarily responsible for performing quality control on new program set-ups and any requested updates

    + Must be proficient in accessing data for affordability programs. Possesses the ability to use data to analyze its significance with regard to the functioning of a program’s business rules in order to investigate and resolve issues.

    + Gains a thorough understanding of the adjudication claims engines and networks, including the variation of system logic across multiple adjudicators

    + Quickly responds to and resolves business rule questions or concerns escalated from internal teams or adjudicators

    + Actively participates in weekly adjudication calls and ad hoc meetings with internal clients. Participates in internal training sessions as necessary.

    Qualifications

    + Bachelor’s degree from a 4-year college or university preferred

    + 1+ years of professional job experience. Experience in the pharmaceutical industry is a plus

    + Knowledge of the pharmaceutical industry and/or healthcare a plus.

    + Proficient skill level in Microsoft Office applications, especially Excel, PowerPoint, Word, and other related database systems

    + Superior written and verbal communication skills

    Travel:

    + Must be willing to travel to CRx offices when needed as requested by supervisor. Must also be willing to travel to adjudicator/s locations when necessary.

     

    Submit a Referral (https://careers-connectiverx.icims.com/jobs/2928/analyst%2c-adjudication/job?mode=apply&apply=yes&in\_iframe=1&hashed=-1834382591)

     

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    LocationUS-NJ-Whippany

    ID2025-2928

    Category Pharmacy

     

    Position Type Full Time

     

    Remote Yes