Senior Analyst, Adjudication

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Design adjudication solutions, interpret business requirements, create technical specifications, and coordinate implementation with external adjudicators.

• Lead intricate root-cause investigations, transaction research, and issue resolution using transaction and program-level data.

• Collaborate with internal and external stakeholders throughout solution design, testing, implementation, and program enhancements.

• Drive the creation of technical documentation, governance, process improvements, work instructions, automation opportunities, developments, and continuous improvement initiatives.

• Mentor Adjudication Analysts, review technical outputs, share expertise, and assist with complex adjudication inquiries.

• Facilitate adjudication training sessions for internal teams and Adjudication Analysts.

• Assist with audits and client inquiries.

• Evaluate technical designs and peer work products to ensure implementation accuracy and consistent solution design.

• Provide support for major client implementations, conversions, product launches, and complex escalations.

• Suggest strategic enhancements to boost operational efficiency, governance, documentation quality, and program outcomes.

⛳️ Requirements

• A bachelor's degree or 6 years of relevant experience is required.

• Over 5 years of experience in supporting pharmaceutical affordability or claims adjudication programs.

• Proven track record in leading complex technical initiatives.

• Advanced understanding of pharmaceutical affordability programs and adjudication workflows.

• Strong grasp of solution architecture, business rule interpretation, and client program design requirements.

• Familiarity with NCPDP claims processing, transaction analysis, and technical documentation standards.

• Knowledge of governance, compliance expectations, and operational controls that support affordability programs.

• Advanced skills in analytical thinking, troubleshooting, and root-cause analysis.

• Proficient in developing technical specifications, validating implementations, and conducting peer reviews.

• Capable of mentoring analysts, disseminating knowledge, and addressing complex adjudication inquiries.

• Proficiency in Microsoft Office and relevant reporting tools.

• Expert knowledge of adjudicators' claims processing systems and related software as required.

• Excellent written and verbal communication skills.

• Ability to tailor communication to various audiences.

• Adherence to SOC1, SOC2, PCI, HIPAA, company/client policies, business rules, ethics, and relevant laws.

• Occasional travel may be necessary to company offices, client locations, or external adjudication vendor sites.

🏝️ Benefits

• Opportunities for bonuses (or commissions).

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Disability insurance.

• 401(k) plan with employer contributions where applicable.

• Flexible paid time off (PTO) policy for exempt employees, encompassing sick days, personal days, and vacations.

• Eight standard company holidays each year.

• Three floating holidays annually.