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Claims Tech Analyst Associate
3 months ago
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Claims Tech Analyst Associate - Remote
Job Description
The Associate Claims Technical Analyst is responsible for serving as the claims analysis resource for an assigned operations team. This role is responsible for performing basic and intermediate level client, member and pharmacy remediation analysis caused by errors coded into the RxClaim claims processing system, along with claims monitoring and data validation activities.
Responsibilities
- Perform standard queries to retrieve data for required analysis
- Research and analyze information by employing analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate data into usable client facing reports
- Perform daily claims monitoring and data validation activities
- Respond to inquiries related to specific job function process or support systems and provide documentation and tracking to resolution
- Other duties as assigned
Minimum Qualifications
- Bachelor's degree in Business, Computer Science, IT, Mathematics, Finance or related area of study, or equivalent combination of education and/or relevant work experience in data analysis; HS diploma or GED required
- Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
- Strong verbal and written communication skills
- Ability to coordinate multiple projects/tasks simultaneously under strict timelines
- Strong analytical, problem solving, and decision-making skills
- Intermediate level Microsoft Excel Analysis Skills
- Ability to work in fast-paced, collaborative team environment
- Experience utilizing basic query tools and Structured Query Language (SQL)
Preferred Qualifications
- Experience with Commercial and Centers for Medicare and Medicaid Services rules and regulations
- Experience working with claims data or systems
Minimum Physical Job Requirements
- Ability to work outside of Prime's core business hours of 9:00 a.m. – 4:00 p.m. as needed
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally may be required to lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
- Reports to a Supervisor or Manager in PBM Operations
Potential pay for this position ranges from $ $37.07 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page ) and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
Positions will be posted for a minimum of five consecutive workdays.
Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at or email
