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:
- Integrity: Always operate with honesty and transparency so we earn the trust of our clients.
- Courage: Demonstrate the courage needed to take on a broken industry and continuously improve what we offer to optimize health outcomes.
- Together: Foster a collaborative and inclusive environment that values teamwork, respect, and open communication, and encourages creativity and diversity of thought.
Job Summary:
As a Claims Operations Analyst, you will be a part of the Plan Operations team with daily activities that support behind the scenes activities related to claims processing, mass member communications, implementation activities, and other technical responsibilities. You will play a supporting role within Plan Operations in performing claims analysis for groups in transition to SmithRx and the downstream communications to members related to potential disruptions.
What you will do:
- Evaluate the accuracy and completeness of claims data and member census information to ensure it can be used in implementation planning activities and member communication
- Analyze claim history data to identify trends, patterns, and potential issues that could impact new members during their transition to SmithRx
- Provide data-driven insights to support the design and execution of implementation strategies, focusing on minimizing member disruption.
- Review and validate the accuracy of communication materials to ensure they reflect correct and up-to-date claims data.
- Work closely with other departments, including IT, compliance, and clinical teams, to ensure that all aspects of claims data analysis are integrated into broader PBM operations.
- Collaborate with data analytics and IT teams to improve the processes for extracting, analyzing, and reporting claims data.
- Contribute to the development of tools, templates, and methodologies that enhance the overall claims analysis function.
What you will bring to SmithRx:
- Bachelor’s degree or equivalent work experience
- At least 4+ years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/ or commercial health insurance experience required
- Pharmacy Technician license preferred
- Advanced skills in Microsoft Excel and ability to manipulate large sets of data required
- Moderate proficiency in SQL required
- Robust problem-solving and analytical skills
- Impeccable attention to detail and accuracy in work product
- Strong organizational, problem-solving, written and verbal communication, and interpersonal skills
- Ability to work independently as well as part of an extended, cross-functional team
- Self-driven, results-oriented work ethic with a positive outlook
What SmithRx Offers You:
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- 12 Paid Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities
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Last updated on Aug 23, 2024