Analyst, Adjudication

ConnectiveRx • Whippany, NJ

4d • $55,000 - $71,500

About The Position

The Adjudication Analyst supports the implementation, maintenance, analysis, and quality assurance of ConnectiveRx pharmaceutical affordability (copay) programs and other adjudicated program offerings. The role handles program setup and maintenance, checks setups and updates for accuracy, investigates adjudication outcomes and data discrepancies, and applies business rules consistently to support operational accuracy and program integrity. The analyst works independently on routine tasks and collaborates with Senior Analysts or Leads on complex issues and continuous improvement in a fast-paced environment.

The position uses Salesforce, ManageEngine, and ConnectiveRx systems, and involves maintaining standard operating procedures, work instructions, job aids, tracking logs, and spreadsheets. It includes participation in scheduled adjudication calls, ad hoc meetings, internal discussions, and training sessions. Travel to ConnectiveRx offices or adjudicator locations may be needed when requested or necessary.

Requirements

• Bachelor’s degree from a four-year college or university, or equivalent experience.
• Minimum 2–4 years of pharmacy technician or adjudication experience.
• Knowledge of healthcare operations claims processing, pharmaceutical affordability programs, or other rules-driven operational environments.
• Understanding of quality-control methodologies, issue investigation, and root-cause analysis.
• Familiarity with interpreting, applying, and questioning documented business rules.
• Awareness of operational standards and documentation.
• Intermediate skill level in Microsoft Office applications.
• Analytical and problem-solving skills, including the ability to conduct independent investigations and research, gather information, identify patterns and relationships between data points, and draw logical conclusions.
• Excellent attention to detail and accuracy in data analysis, quality checks, and documentation.
• Active listening and effective written and verbal communication skills to convey findings, issues, and recommendations; ability to share relevant information and adapt messages to different audiences.
• Detail-oriented, analytical, organized, able to multitask and manage time, quick to learn, and able to work accurately and collaboratively both independently and as part of a team.
• Willingness to travel to ConnectiveRx offices when requested by a supervisor and to adjudicator locations when necessary.

Nice To Haves

• Prior experience performing quality checks, operational analysis, or investigative work.

Responsibilities

• Assist with setup and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings.
• Respond to and resolve business-rule questions or concerns escalated by internal teams or adjudicator partners, escalating complex issues as appropriate.
• Conduct quality-control reviews of new program setups and requested updates to verify accuracy, consistency, and adherence to established rules and standards.
• Access, analyze, and interpret program and adjudication data to evaluate rule functionality; investigate discrepancies, anomalies, or incorrect outcomes and document findings.
• Develop and maintain working knowledge of adjudication claims engines and networks, including differences in system logic across adjudicators.
• Use Salesforce, ManageEngine, and ConnectiveRx systems to fulfill requests.
• Support documentation updates and process improvements; primarily maintain SOPs, work instructions, job aids, tracking logs, and spreadsheets.
• Participate in regularly scheduled adjudication calls, ad hoc meetings, internal discussions, and training sessions as required.
• Travel to ConnectiveRx offices when requested by a supervisor and to adjudicator locations when necessary.

Benefits

• Medical, dental, vision, life, and disability insurance.
• 401(k) plan, with employer contributions where applicable.
• Flexible paid time off for exempt employees, covering sick days, personal days, and vacations.
• Eight standard company holidays and three floating holidays annually.
• Opportunities for a bonus or commissions.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level