Rx Claims SME - W2 Only

About the role

This position is responsible for providing deep knowledge on RxClaim adjudication, claims processing, and MedD claims. The candidate will also need to demonstrate extensive knowledge of PBM concepts such as drug pricing, copays, accumulators, and Drug Utilization Review (DUR).

Responsibilities

• Facilitate discussions with Product Owners, Business, and clarify business requirements.
• Execute root cause analysis, manage data validation, and navigate automated database systems/reporting tools.
• Deep knowledge in business & plan configuration and plan option knowledge.

Requirements

10+ years of experience in similar roles.

Qualifications

• In-depth knowledge on RxClaim Adjudication, claims processing, MedD claims.
• Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR).
• High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.

Skills

• Strong analytical skills.
• Excellent communication and problem-solving abilities.

Benefits

N/A

Pay

N/A

Schedule

N/A