Pharmacy Adjudication Analyst

Job Summary

A company is looking for an Analyst, Adjudication.

Key Responsibilities

• Assist in the set-up and maintenance of affordability programs and adjudicated program offerings
• Resolve business rule questions escalated by internal teams or adjudicator partners, escalating complex issues as necessary
• Conduct quality control reviews on program setups and updates to ensure accuracy and adherence to established rules

Required Qualifications

• Bachelor's degree from a 4-year college or university or equivalent experience required
• Minimum 2-4 years of pharmacy technician/adjudication experience, preferably with quality checks or operational analysis
• Knowledge of healthcare operations, claims processing, and pharmaceutical affordability programs
• Understanding of quality control methodologies and issue investigation
• Familiarity with various tools such as Salesforce and CRx systems