Capital Rx is looking to solve the problem of reducing healthcare costs by providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities through its cloud-native enterprise health platform, Judi.
Requirements
- 1+ years of experience in an Analyst role, Software Engineering role or related work experience
- 1+ year of PBM or Health Plan operations experience with pharmacy claims data and reimbursement methodologies.
- Experience performing complex analyses on large sets of data
- Experience working with structured and unstructured data
- Proficient in SQL, JSON, Java, R, Excel, and other data visualization tools
- Experience working with AWS Redshift
- Pharmacy Benefit Management analytics preferred
Responsibilities
- Accountable for accurate translation of network data and reporting requirements of Capital Rx’s Software as a Service (SaaS) customers for migration and ongoing use of JUDI.
- Support all network analytics needs of internal team members and customers.
- Execute and support existing processes such as, but not limited to: Assist with intake and conversion of files necessary for parallel Network Validation data review.
- Develop Network testing automation.
- Support Network and Provider Agreement data reporting, claims analysis, or other network pricing related reporting
- Develop and maintain data reporting repositories as it relates to all facets within the network setup.
- Perform QA and claims testing to validate that network data loads yield appropriate adjudication results.
Other
- Ability to shift between competing priorities and meet organizational goals.
- Excellent verbal, written, interpersonal and presentation skills.
- Ability to work effectively with virtual teams.
- Ability to travel 5-10%
- Bachelor's Degree preferred, or equivalent combination of education, training, and experience.
