Sal:$79,000 – $138,000 a year
Responsibilities:
Collaborate with internal subject matter experts (Business Intelligence, Data Engineering, Pricing Operations, Program Implementation, and Account Management) to develop robust processes and ensure accurate and timely reporting of pharmacy claims activity.
Develop standard processes for auditing claims data on a recurring basis, identifying trends, patterns, discrepancies, and potential errors.
Support audit requests by external partners and vendors by providing validated and structured data.
Ensure data accuracy, reliability, and adherence to program business rules and benefit design; proactively identify and address data issues.
Partner with Finance on month-end activities, reimbursement workflows, and revenue recognition.
Collaborate with Sales Operations to support optimal sales pipeline reporting to Commercial leadership.
Perform quality control on new program setups and requested updates.
Maintain detailed records of testing activities, findings, and corrective actions.

Skills & Qualifications:
3–5 years of professional experience in complex QA environments involving pharmacy claims
Healthcare and claims data experience preferred
Proven ability to develop effective QA logic and testing methodologies.
Excellent written and verbal communication skills and keen attention to detail.
Deep understanding of claims adjudication engines and system logic variations across different adjudicators.
Strong proficiency in SQL and tools such as Looker, Excel, and Google Sheets.
Critical thinking skills and a creative approach to problem-solving.
A strong curiosity and interest in healthcare technologies.
Education and Experience:
Bachelor’s degree preferred, or equivalent practical experience in a relevant field such as healthcare technology, pharmacy benefits, or data analysis.