Pharma Claims Analytics Specialist

Forhyre; North Carolina; On-site; USD 65,000 - 93,000; Full time

Job summary

Forhyre in the United States seeks a Claims Business Analyst to bridge IT capacity with business goals by supporting analytics, building, testing, and deployment of our software product’s features.

This role collaborates with the Director of Claims to deliver timely claims payments and improve call flows and customer experience while ensuring quality performance and reduced inventory.

Qualifications

• Experience with technology, systems and IS departments.
• Strong Excel skills and ability to analyze data.
• Knowledge of ICD-10 and CPT-4 coding and medical terminology.
• Proficiency with Windows, Word and business analytics tools.
• Analytical and problem-solving capabilities.
• Excellent communication with staff and management.
• Experience in pharmacy claims processing and managed care.
• Understanding of payer/PBM market and NCPDP/HIPAA basics.
• Awareness of pharmacy claim workflows (Enrollment, Utilization, Adjudication, Pricing).
• Ability to present information and collaborate across a product team.
• Documenting business requirements and user journeys.
• Agile project execution experience and knowledge of scrum tools.

Responsibilities

• Develop KPIs for claim processing and call center performance.
• Automate work distribution and maintain department dashboards.
• Prepare weekly/monthly/quarterly reports for management.
• Summarize operational and claim data for stakeholders.
• Ensure on-time deliverables and communicate issues to leadership.
• Identify trends and provide actionable recommendations.
• Refine tools with managers and SMEs for efficiency.
• Create data definitions, validate and merge data from sources.
• Coordinate report creation and system change implementations.

Skills

Excel

Analytical skills

Communication

Agile

Requirements gathering

Team collaboration

Pharmacy claims

Payer/PBM knowledge

ICD-10/CPT-4

Med D workflows

Tools

Scrum tools

BI tools

Job description

Forhyre in the United States seeks a Claims Business Analyst to bridge IT capacity with business goals by supporting analytics, building, testing, and deployment of our software product’s features.

This role collaborates with the Director of Claims to deliver timely claims payments and improve call flows and customer experience while ensuring quality performance and reduced inventory.