Analyst, Adjudication

ConnectiveRx • Hanover Township, NJ

6d • $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 is accountable for program setup and maintenance, quality control of setups and updates, investigation of adjudication outcomes and data discrepancies, and consistent application of business rules to maintain operational accuracy and program integrity.

The analyst works independently on routine tasks and collaborates with Senior Analysts or Leads on complex issues. The position contributes to issue resolution and continuous improvement in a fast-paced environment, using adjudication systems and tools such as Salesforce, ManageEngine, and CRx systems. Travel to ConnectiveRx offices or adjudicator locations may be required 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.
• Proficient analytical and problem-solving skills, including conducting independent investigations by gathering information, identifying patterns and relationships between data points, and drawing logical conclusions from data.
• Excellent attention to detail and accuracy in data analysis, quality checks, and documentation.
• Active listening and effective written and verbal communication skills for conveying findings, issues, and recommendations.
• Ability to share only relevant information and adapt communication to different audiences.
• Detail-oriented, analytical, organized, and able to multitask; strong time-management skills, quick learning ability, and ability to work accurately and collaboratively both independently and as part of a team.
• Willingness to travel to ConnectiveRx offices when requested and to adjudicator locations when necessary.

Nice To Haves

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

Responsibilities

• Assist with the 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 ensure 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 CRx systems to fulfill requests.
• Support documentation updates and process improvements; maintain SOPs, work instructions, job aids, tracking logs, and spreadsheets.
• Participate in scheduled adjudication calls, ad hoc meetings, and internal discussions, and attend training sessions as required.
• Travel to ConnectiveRx offices when requested by a supervisor and to adjudicator locations when necessary.

Benefits

• Opportunity for a bonus or commissions; total compensation varies based on factors including location, relevant skills, experience, and capabilities.
• Medical, dental, vision, life, and disability insurance.
• Participation in the company’s 401(k) plan, with employer contributions where applicable.
• Flexible paid time off for exempt employees, covering sick days, personal days, and vacations; the amount is determined based on the employee’s first year of service.
• Eight standard company holidays and three floating holidays annually, with first-year prorations.

What This Job Offers

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