The Adjudication Analyst will work cross-functionally with business and technology organizations to develop and implement streamlined solutions to platform workflows. Assist the team in designing processes to support integral PBM adjudication analytics that contribute to the ongoing success of the SmithRx solution. Effectively champion a robust, accurate and cost-effective PBM adjudication solution for our clients and members.
Assist with delivering technical data support in the development and implementation of Underwriting packaged software solutions. Serve as the subject matter expert for an existing application area, including data definitions, usage and file structure, technical structure of the code and the business rules, and structure of requirements that govern the functionality of the system. Analyze application and system problems and incidents; develop recommendations and solutions for those problems, implement those solutions, and provide communications on the associated actions, business impacts, and results.
Blue Cross and Blue Shield of North Carolina is committed to better health and better health care in their communities and beyond.
Align platform integrations with core business processes. Translate business requirements into functional specifications for EDI integrations. Collaborate with cross-functional teams to ensure integrated process flows align with operational goals.
Cleo Communications, LLC is an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment.
Quantify program impact with actuarial and claims analyses.
Deliver standardized financial and clinical outcome reporting for customers.
Collaborate with data scientists to build and iterate financial models.
Virta Health is on a mission to transform type 2 diabetes and weight-loss care through innovations in technology, personalized nutrition, and virtual care delivery.
Lead initiative, in collaboration with the Account Management team to ensure that SmithRx performance analysis is completed and value is communicated to clients.
Build a 'performance assessment playbook' to ensure SmithRx is ahead of all contract performance accountability processes.
Actively participate in deal assessment for ongoing retention activity.
SmithRx is a rapidly growing, venture-backed Health-Tech company disrupting the Pharmacy Benefit Management (PBM) sector with a next-generation drug acquisition platform. The company has a mission-driven and collaborative culture that inspires employees to do their best work.
Intake, triage, and perform Level 1 technical troubleshooting for production support cases. Accurately document all findings, steps taken, reproduction details, and relevant information within the ticketing system. Collaborate cross-functionally with Development, QA, Client Services, Payer Relations, and other internal departments as needed to progress resolution.
DentalXChange understands the importance of privacy and takes seriously the need to protect job applicants’ personal information.
Troubleshoot complex product and technical issues to determine severity and scope and respond accordingly. Manage issues and questions escalated from Customer Support, Account Management, and Implementation teams. Educate and empower customers to maximize use of products, tools, and services.
Experian is a global data and technology company, powering opportunities for people and businesses around the world.
Support the day-to-day data needs of internal clients. Clarify requests and prepare data. Perform list matches using in-house tools and MS Excel.
M3 is a Japanese global leader providing technological and research solutions to the healthcare industry, with over 5.8 million physician members globally.
Responsible for implementation and support of applications and works with end users to troubleshoot and correct problems.
Researches and evaluates a variety of solutions to provide end users with high quality, efficient products.
Participates in the planning, development, implementation, maintenance, support and evaluation of clinical or business application systems.
The University of Kansas Health System is a world-class healthcare provider and destination for complex care and diagnosis. They are driven by their commitment to service, continuous improvement and to the highest degree of excellence.
Analyze support trends and customer usage patterns to identify optimization opportunities.
Develop proactive solutions and recommendations to prevent recurring issues.
Create customer-specific guidance and best practices to improve system utilization and ROI.
Transact and CBORD have joined forces as industry leaders to bring the best integrated technology solutions to education, healthcare, and business campuses worldwide.
Deliver on-demand, automated, and customizable reporting and insights. Identify, analyze, and interpret trends or patterns in complex data sets. Contribute to developing scalable, self-service BI dashboard.
RxSense is a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits.
Perform auditing of claims, ensuring processing, payment, and financial accuracy.
Complete reporting of audits finalized with decision methodology for procedural and monetary errors.
Communicate corrections and adjustments to Examiners as identified on pre-payment audits.
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their bills.
Oversee a team of pharmacy technicians in the prior authorization process. Analyze data and provide recommendations to maximize team agility and performance. Generate and deliver reports on technician metrics to stakeholders.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans.
As the PARS Client Liaison, you will report to Experian Health and manage the partnership between the Payment Appeal Recovery Service (PARS) and the Client. As the primary contact, you will work with Experian Health departments and PARS staff to ensure client satisfaction and Return on Investment. You will present PARS Activity Reviews and Contract Manager Reports to the client throughout the client life cycle.
Experian is a global data and technology company, powering opportunities for people and businesses around the world.
Conduct research and analyze data to inform key decisions. Partner with cross-functional teams to reconcile inputs and clarify assumptions. Support the creation of executive-ready presentations and reports.
ServiceNow stands as a global market leader, bringing innovative AI-enhanced technology to over 8,100 customers, including 85% of the Fortune 500®.