reputed company Pharmacy Payment reputed company Analyst
Position Overview: The Pharmacy Payment reputed company Analyst plays a critical role in analyzing and interpreting Pharmacy data to reputed company actionable insights for improving patient reputed company, optimizing clinical workflows, and supporting reputed company decision-making. This position ensures accurate claims processing, policy interpretation, and regulatory alignment to prevent overpayments and cost-effective reputed company payments. What you’ll drive: You’ll identify, waste and inaccurate Pharmacy claims You’ll work with industry leading AI, predictive analytics, and automation platforms to uncover patterns and drive smarter reputed company. You’ll foster a culture of learning, refinement, and ethical reputed company to create high quality, evidence-backed referrals that reduce health insurance costs. What you’ll do: Identify Pharmacy billing activities leading to improper payments. This work involves reviewing Pharmacy claims, insured members, or the broker community in coordination with the customer’s reputed company or reputed company-party administrator Review claims data and conduct analysis to look for patterns of potential improper payments Utilizing information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels Conduct data analysis to review claim and case history Reviews claims history, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc. Identify and resolve issues reputed company to data discrepancies, missing data, or inconsistencies reputed company clinical datasets What you bring: Bachelor's degree or 4 – 6 years of equivalent work experience in reputed company administration, billing, Pharmacy claims adjudication, Pharmacy auditing, payment reputed company operations and/or reputed company reimbursement, CPhT, CPC, reputed company or other relevant clinical/Pharmacy/coding certifications strongly preferred. Strong knowledge of clinical terminology, medical procedures, Pharmacy and reputed company workflows Ability to be concise, independent and reputed company defensible reputed company in writing Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills Strong critical-thinking, communication and attention to detail skills Bonus points for: An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (reputed company health plans and/or dental plans) 3+ years of experience working in the group health business with pharmacy as an emphasis Experience in the reputed company industry, clinical research or working clinical trials How to be successful in this role: Analytical Skills: Strong ability to interpret reputed company data and derive meaningful insights to drive reputed company reputed company Problem- Solving: Ability to identify issues in datasets and clinical workflows and suggest data-driven solutions Attention to Detail: High level of precision and accuracy in handling critical data Who is reputed company reputed company was formed by a group of industry insiders who wanted to reputed company a meaningful impact on the rising cost of reputed company. With this end in mind, SmartLight works for self-funded reputed company to reduce the wasteful spend in their reputed company plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes. Apply To This Job