Analyst, Data Exchange - Eligibility

4 hours, 33 minutes ago
Full-time
Junior
Data Science and Analytics
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Attend new client implementation meetings with external partners to review eligibility requirements and protocols.
  • Recommend eligibility file formats and coordinate the receipt and processing of eligibility data from external partners.
  • Serve as a subject matter expert on eligibility guidelines and EDI protocols.
  • Coordinate identification and resolution of member eligibility issues with internal teams and external partners.
  • Identify, triage, and resolve errors related to transferring, loading, and managing eligibility data.
  • Monitor system status and eligibility data to detect abnormalities that may affect data quality and accuracy.
  • Ensure issues and errors are resolved according to operating standards and service-level expectations.
  • Validate eligibility data integrity through regular audits and reconciliation processes.
  • Ensure accurate and timely entry of group and plan structure determinations for benefits and enrollment.
  • Follow the Judi Health Code of Conduct and report noncompliance when required.

Requirements

  • Bachelor’s degree.
  • 1+ years of previous work experience, preferably in PBM, healthcare, data exchange, or eligibility.
  • Ability to match key PBM concepts and data fields across systems and file layouts to ensure data transfer consistency and accuracy.
  • Ability to analyze complex business problems and identify root causes.
  • Proficiency in SQL, Excel, JSON, and other technical data skills preferred.
  • Strong communication skills and ability to build effective working relationships with internal and external stakeholders.
  • Self-motivated, detail-oriented, and able to solve problems independently.
  • Ability to manage multiple competing priorities in a dynamic environment and collaborate effectively in a team.
  • Experience in PBM, healthcare, data exchange, or eligibility is preferred.
  • Remote work or hybrid work eligibility based on location in Denver, CO or the NYC area.

Benefits

  • Remote (for non-local candidates) or hybrid work options for local candidates in Denver, CO or the NYC area.
  • Base salary range of $76,800-$121,000 for remote US candidates.
  • Base salary range of $96,800-$121,000 for New York, NY candidates.
  • Base salary range of $88,000-$111,000 for Denver, CO candidates.

Interested in this position?

Apply directly on the company website

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