Adjudication Analyst at SmithRx (Provo, UT)

| Provo, UT
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Who we are:

SmithRx is a rapidly growing, venture-backed Health-Tech company.  Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service.  With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our Company values of:

  • Integrity: Do the right thing. Especially when it’s hard.
  • Courage: Embrace the challenge.
  • Together: Build bridges and lift up your colleagues.

Job Summary:

With fast-paced growth comes a multitude of platform data-related opportunities to explore and challenges to navigate. SmithRx’s Adjudication Team leads mission-critical claims processing and related data management. The team is the frontline resource for identifying, researching and troubleshooting a multitude of adjudication and data challenges.

SmithRx Adjudication Platform is the “engine room” of the SmithRx PBM solution for benefit claims processing and adjudication. The adjudication team collaborates with various internal teams to ensure seamless execution for members, clients, and other key stakeholders.

The Adjudication Analyst will operate as a part of SmithRx’s growing Adjudication Team. Candidate will work cross-functionally with our business and technology organizations to develop and implement streamlined solutions to adjudication workflows. Candidate will assist the team in designing processes to support integral PBM adjudication analytics that contribute to the ongoing success of the SmithRx platform. Our goal is to assist our business partners and effectively champion a robust, accurate and cost-effective PBM adjudication solution for our clients and members.

What you will do:

  • Serve as subject matter expert and provide front-line technical and analytical resolution on the SmithRx adjudication platform and all of its components for (1) eligibility, (2) plan design, (3) claims adjudication and (4) accumulator data file exchange
  • Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquiries submitted by our internal business partners.
  • Perform troubleshooting of all mission-critical adjudication issues to triage and resolve issues in a timely manner
  • Perform in depth analysis of claims data inconsistencies and develop output reports detailing resolution and data validation
  • Partner closely with our Customer Success and Account Management organizations to ensure that all of their data-related needs are met
  • 5% travel to San Francisco/ Utah will be required

What you will bring to SmithRx:

  • Bachelor’s degree or equivalent experience preferred
  • 2-5 years of work experience working with medical or pharmacy claims data required
  • Pharmacy claims adjudication experience required
  • EDI experience preferred, but not required
  • Intermediate skill in SQL (preferably PostgreSQL)
  • Intermediate skill in Microsoft Excel
  • Robust analytical skills, ability to think critically about data
  • Curiosity and excitement to learn deeply about pharmacy adjudication under the guidance of industry-leading experts
  • Strong communication skills, both in-person and written
  • Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments
  • Execution-focused ethos - you are a solutions-oriented problem solver and efficiency driven
  • Flexible, adaptable, and able to respond under the pressure of a fast-paced technology company

What SmithRx Offers You: 

  • Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, Life insurance 
  • Discretionary Time Off 
  • 401(k) Retirement Savings Program
  • Flexible Spending Benefits  
  • Paid Parental Leave benefits
  • Professional development and training opportunities 
More Information on SmithRx
SmithRx operates in the Pharmaceutical industry. The company is located in San Francisco, CA. SmithRx was founded in 2016. It has 46 total employees. It offers perks and benefits such as Health insurance, 401(K). To see all 12 open jobs at SmithRx, click here.
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