Adjudication Analyst

Job Title: Adjudication Analyst
Job Location: Whippany, NJ
Job Duration: 5-6 Months (possibility of extension)
Shift: Monday - Friday, 9:00am - 5:30pm
Payrate: $27.60 - $33.37/hr. on w2

Job Summary:

• The Adjudication Analyst is responsible for various operational aspects of the implementation, support, analysis, and quality assurance of client’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.

Duties and Responsibilities % of time:

• Assists in the set-up and maintenance of affordability programs and other Client adjudicated program offerings 30%.
• Is primarily responsible for performing quality control on new program setups and any requested updates 25%.
• Products a thorough understanding of the adjudication claims engines and networks, including the variation of system logics across multiple adjudicators 15%.
• 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%.
• Quickly responds to and resolves business rule questions or concerns escalated from internal teams or adjudicators 10%.
• Other duties as assigned.
  • Actively participates in weekly adjudication meetings and ad hoc meetings with internal clients 10%.

Compliance Requirements:

• Adhere to all Company Policies, Procedures, and other training consistent with client'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.

Required Skills:

• 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.

Travel Requirements:

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