TL;DR

Adjudication Analyst: Supporting and improving the %hirify_global% adjudication platform with an accent on claims adjudication, data analysis, and customer support. Focus on troubleshooting, data validation, and cross-functional collaboration to enhance pharmacy benefit management workflows.

Location: Remote (US)

Company

%hirify_global% is a rapidly growing, venture-backed Health-Tech company focused on transforming the Pharmacy Benefit Management sector with innovative technology and cost-saving tools.

What you will do

Provide front-line technical and analytical support for the adjudication platform covering eligibility, plan design, claims adjudication, and data exchange.
Address and resolve escalation issues related to adjudicated claims and data sharing.
Troubleshoot mission-critical adjudication issues to ensure timely resolution.
Analyze claims data inconsistencies and develop detailed resolution reports.
Collaborate with Plan Operations, Account Management, and engineering teams to streamline customer issue resolution processes.
Conduct User Acceptance Testing on software solutions and enhancements.

Requirements

Must have at least 2+ years of experience in claims processing, medical billing, healthcare or pharmacy benefits, or commercial health insurance.
Intermediate SQL skills (preferably PostgreSQL) and Microsoft Excel proficiency.
Strong analytical and communication skills.
Bachelor’s degree or equivalent experience preferred.
Self-starter mentality with problem-solving and execution focus.
Ability to work effectively in a fast-paced technology environment.

Culture & Benefits

Comprehensive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance.
401(k) Retirement Savings Program and Flexible Spending Benefits.
Paid parental leave, discretionary time off, and 13 paid holidays.
Employee Assistance Program and wellness resources like Spring Health, Gympass, and Headspace.
Professional development and training opportunities.