Adjudication Analyst

The Adjudication Analyst is responsible for various operational aspects of the implementation, support,

analysis, and quality assurance of ***’s pharmaceutical affordability (copay) programs. The

candidate will be accountable for program set-ups and maintenance and will participate in issue

resolution and quality checks. This position calls for an analytical, detailed oriented person, who works

well on a team, is motivated by a fast-paced environment, and is proficient at problem solving. 1. Assists in the set-up and maintenance of affordability programs and other

•** adjudicated program offerings

30%

2. Is primarily responsible for performing quality control on new program setups and any requested updates

25%

3. Products a thorough understanding of the adjudication claims engines and

networks, including the variation of system logics across multiple

adjudicators

15%

4. Must be proficient in accessing the data from affordability programs and in

being able to analyze its significance with regard to the functioning of a

program’s business rules

15%

5. Quickly responds to and resolves business rule questions or concerns

escalated from internal teams or adjudicators

10%

6. Other duties as assigned

a. Actively participates in weekly adjudication meetings and ad hoc

meetings with internal clients

10% •Adhere to all Company Policies, Procedures, and other training consistent with ***'s Information Security and Compliance Programs, including but not limited to the following compliances and regulations: SOC1, SOC2, PCI, HIPAA

• Maintain strict compliance with company and client policies regarding business rules and ethics, as well as applicable local, state and national federal law



•Proficient skill level in Microsoft office, especially Excel, PowerPoint, and other related database systems

• Process Knowledge: Identifies, documents, and monitors key processes needed to achieve successful business results. Maps and documents processes. Develops framework for process

improvement. Identifies and documents processes within area of responsibility. Seeks guidance on aspects of process that are out of immediate Product. Drafts procedures that comply with the process. Implement process improvement recommendations within the context of overall business processes.

• Decision Quality: Ability to make appropriate, informed and timely decisions while ensuring compliance with company policies, practices and core values. Uses a combination of analysis,

knowledge, experience, and judgment to make decisions. Makes effective decisions, even in the

absence of complete information. Evaluates and prioritizes factors, weighs decisions in order to reach a sound and effective solution to a problem.

• Service Orientation: Anticipate, identify, and address the needs of customers/clients, sometimes before those needs are voiced. Actively looks for ways to help people; ability to be thoughtful, empathetic to the needs of others. Is prompt and courteous in ensuring that the customer's

immediate needs or complaints are satisfied. Focuses on improving the level of service provided to external and internal customers.

• Consultation Communication: The ability to provide guidance to organizational stakeholders. Offers solutions based upon best practices, generates specific organizational interventions (e. g.,

culture change, change management, restructuring, training, etc. ) to support organizational objectives.

• Must travel to main office when needed as requested by supervisor. Must also be willing to travel to adjudicator/s locations when necessary