Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Claim Technical Analyst - JUDI Ops Team - RemoteJob Description

The Claims Technical Analyst is responsible for serving as the claims analysis resource for an assigned operations team. This role is responsible for developing queries to retrieve data and performing intermediate level and some complex client, member and pharmacy remediation analysis caused by errors coded into the JUDI claims processing system. This position also researches and tests system capabilities.

Responsibilities

Develop and perform complex queries to retrieve data for required analysisResearch and analyze information by employing more advanced analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate complex data into usable client facing reportsResearch, test, and respond to inquiries regarding JUDI system capabilities; update department documentation with information gained from researchIdentify and participate in implementing department level process improvementsOther duties as assigned

Minimum Qualifications

Bachelor's degree in business, Computer Science, IT, Mathematics, Finance or related area of study; or equivalent combination of education and/or relevant work experience; HS diploma or GED required2 years of work experience in data analysis, in the healthcare, insurance, finance or related industryMust be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Strong verbal and written communication skillsAdvanced reporting skillsRunning manual processesAbility to coordinate multiple projects/tasks simultaneously under strict timelinesStrong analytical, problem solving, and decision-making skillsAbility to work in fast-paced, collaborative team environmentIntermediate level Microsoft Excel Analysis SkillsAbility to present complex material to a variety of audiences in plain languageStrong negotiation and persuasion skillsExperience utilizing query tools and Structured Query Language (SQL)

Preferred Qualifications

Experience with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations1 year of experience working with claims systems

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.