Senior Adjudication Analyst

Job Summary

Serving as a technical subject matter expert, the full-time remote Senior Adjudication Analyst will lead complex technical work, architect adjudication solutions, and partner with stakeholders to ensure accurate and compliant affordability programs.

Key responsibilities

• Architect adjudication solutions and coordinate implementation with external adjudicators
• Lead root-cause investigations and issue resolution using transaction and program-level data
• Drive technical documentation, governance, and continuous improvement initiatives

Required qualifications

• Bachelor's degree or 6 years of relevant experience required
• 5+ years of experience in pharmaceutical affordability or claims adjudication programs
• Advanced knowledge of adjudication workflows and NCPDP claims processing
• Strong understanding of solution architecture and business rule interpretation
• Ability to mentor analysts and support complex adjudication questions