[Remote] Adjudication Analyst at SmithRx

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor’s degree or equivalent experience
At least 2+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/or commercial health insurance experience
EDI experience
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
Strong communication skills, both in-person and written
Self-starter mentality
Execution-focused ethos
Ability to adapt to a fast-paced technology company environment

Responsibilities

Serve as customer support to internal stakeholders to provide front-line technical and analytical resolution on the SmithRx adjudication platform and its components
Address planned and unplanned escalation issues related to adjudicated claims and data sharing inquiries
Perform troubleshooting of mission-critical adjudication issues
Perform in-depth analysis of claims data inconsistencies and develop output reports
Partner with Plan Operations and Account Management organizations to ensure data-related needs are met
Collaborate with business partners and engineering to create streamlined processes for customer issue resolution
Conduct User Acceptance Testing on software solutions and enhancements

SmithRx

Pharmacy benefit management with transparent pricing

About SmithRx

SmithRx operates as a Pharmacy Benefit Manager (PBM) that focuses on managing prescription drug plans for self-insured employers and plan sponsors. The company uses a transparent pricing model called "Pass Through Pricing," where it charges only an administrative fee and passes all rebates from prescriptions directly to clients and their members. This model contrasts with traditional PBMs that often inflate drug prices and retain rebates for profit. SmithRx's clients benefit from a technology platform that utilizes real-time data to improve service delivery, ensuring efficient and high-quality pharmacy benefit management. The company also provides a concierge service to enhance support for both members and clients. SmithRx aims to simplify pharmacy benefits while maximizing value for its clients through transparency, advanced technology, and exceptional customer service.

San Francisco, CaliforniaHeadquarters

2016Year Founded

$94.8MTotal Funding

SERIES_CCompany Stage

HealthcareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Unlimited Paid Time Off

Paid Holidays

Wellness Program

Commuter Benefits

Parental Leave

Mental Health Support

Professional Development Budget

Risks

Increased competition from technology-driven PBMs like Capital Rx could erode market share.

Rapid technological advancements may require costly updates to SmithRx's platform.

Potential regulatory scrutiny on PBM pricing models could impact SmithRx's business model.

Differentiation

SmithRx uses a transparent 'Pass Through Pricing' model, unlike traditional PBMs.

The company leverages real-time data for efficient pharmacy benefit management services.

SmithRx offers concierge-level service, enhancing customer satisfaction and support.

Upsides

SmithRx secured $60M in Series C funding, indicating strong investor confidence.

Partnership with Banjo Health enhances prior authorization processes using AI technology.

Collaboration with TheracosBio offers cost-effective drug options for Type 2 Diabetes.

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