Manage a specialized data operations team, ensuring accuracy and security of client eligibility and accumulator data.
Oversee SFTP setup, coding automations, and change control for data processes in a PBM environment.
Serve as Scrum Master and meet directly with clients to resolve data issues and escalations.
AffirmedRx improves healthcare outcomes by bringing clarity to pharmacy benefit management, focusing on transparency and clinical approaches. The company is mission-driven, values trust and accountability, and supports a culture where team members thrive.
Ensure timely and accurate adjudication and payment of medical claims.
Process appeals and disputes by gathering and verifying claim information.
Work independently and as part of a team to meet daily processing quotas.
Sana is a health plan solution built for small and midsize businesses, designed around integrated primary care. Founded in 2017, Sana is remote-first with a fully distributed team across the U.S., valuing curiosity, ownership, and speed.
Support cross-functional teams during implementations to build and manage pharmacy benefit plans on various platforms.
Work with clients to identify and understand benefit plan requirements, and maintain accurate benefit configuration.
Provide troubleshooting support for claims adjudication and collaborate with teams to improve member experience.
SmithRx is a rapidly growing health-tech company disrupting the pharmacy benefit management sector with a next-generation drug acquisition platform. With hundreds of thousands of members onboarded since 2016, they have a mission-driven and collaborative culture inspiring employees to do their best work.
Update and maintain provider file databases with submitted documentation.
Research and resolve provider contract file edits and claims issues.
Analyze reports for data corrections and ensure quality control of provider files.
Blue Cross Blue Shield of Arizona is a health insurance company dedicated to inspiring health and making it easy. With over 80 years of service and more than one million members, they offer a hybrid work environment called Workability that emphasizes flexibility.
Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Advanced Technologies & Laboratories International (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit for the World Trade Center Health Program. The company offers a competitive total compensation package including paid leave, medical, dental, vision, and a 401(k) retirement plan.