The Adjudication Analyst is responsible for supporting the implementation, maintenance, analysis, and quality assurance of ConnectiveRx pharmaceutical affordability (copay) programs.
USD $55,000.00 - USD $71,500.00 /Yr.
- Assists in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings.
- Respond to and resolve business rule questions or concerns escalated by internal teams or adjudicator partners, escalating complex issues as appropriate.
- Conduct quality control reviews on new program setups and requested updates to ensure accuracy, consistency, and adherence to established rules and standards.
- Access, analyze, and interpret program and adjudication data to evaluate rule functionality; investigate discrepancies, anomalies, or incorrect outcomes and document findings.
- Develop and maintain a working knowledge of adjudication claims engines and networks, including differences in system logic across multiple adjudicators.
- Bachelor’s degree from 4-year college or university or equivalent experience
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