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Adjudication Analyst



Posted on Thursday, September 14, 2023

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

  • Integrity: Do the right thing. Especially when it’s hard.
  • Courage: Embrace the challenge.
  • Together: Build bridges and lift up your colleagues.

Job Summary:

The Adjudication Analyst will operate as a part of SmithRx’s growing Customer Support Team. In this role, you will work cross-functionally with our business and technology organizations to develop and implement streamlined solutions to platform workflows. You will assist the team in designing processes to support integral PBM adjudication analytics that contribute to the ongoing success of the SmithRx solution. Our goal is to assist our business partners and effectively champion a robust, accurate and cost-effective PBM adjudication solution for our clients and members.

What will you do:

  • Serve as customer support to internal stakeholders to provide front-line technical and analytical resolution on the SmithRx adjudication platform and all of its components for (1) eligibility, (2) plan design, (3) claims adjudication and (4) accumulator data file exchange.
  • Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquiries submitted by our internal business partners.
  • Perform troubleshooting of all mission-critical adjudication issues to triage and resolve issues in a timely manner.
  • Perform in depth analysis of claims data inconsistencies and develop output reports detailing resolution and data validation
  • Partner closely with our Plan Operations and Account Management organizations to ensure that all of their data-related needs are met
  • Collaborate with business partners and engineering to create streamlined processes for customer issue resolution
  • Conduct User Acceptance Testing on software solutions and enhancements

What will you bring to SmithRx:

  • Bachelor’s degree or equivalent experience preferred
  • At least 2+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/or commercial health insurance experience required
  • EDI experience preferred
  • Intermediate skill in SQL (preferably PostgreSQL) required
  • Intermediate skill in Microsoft Excel
  • Robust analytical skills, ability to think critically about data
  • Curiosity and excitement to learn deeply about pharmacy adjudication under the guidance of industry-leading experts
  • Strong communication skills, both in-person and written
  • Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments
  • Execution-focused ethos - you are a solutions-oriented problem solver and efficiency driven
  • Flexible, adaptable, and able to respond under the pressure of a fast-paced technology company

What SmithRx Offers You:

  • Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, Life insurance
  • Flexible Spending Benefits
  • Discretionary Time Off
  • 401(k) Retirement Savings Program
  • Commuter Benefits
  • Paid Parental Leave benefits
  • Professional development and training opportunities