Pharmacy Claims Analytics Specialist

Capital Rx Inc.; Charlotte (NC); Hybrid; USD 111,000 - 157,000; Full time

Job summary

Judi Health is seeking a highly analytical Analyst to join our Analytics team and support pharmacy claims integrity, adjudication validation, and operational excellence. The role uses SQL and large-scale pharmacy data to investigate outcomes, validate pricing configurations, and ensure accurate adjudication in line with contractual and regulatory requirements.

The ideal candidate combines strong analytical and technical skills with curiosity about how pharmacy claims are processed.

Qualifications

• 4-6 years of experience in healthcare analytics or a related field.
• Advanced SQL skills with the ability to analyze large datasets.
• Experience performing pharmacy reimbursement, network pricing, financial reconciliation, contract compliance, or payment-integrity analysis.
• Ability to interpret complex contractual pricing terms and convert them into documented calculations, validation rules, and analytical test cases.
• Experience investigating discrepancies across claims, pricing reference data, contract terms, adjudication logic, and financial outputs.

Responsibilities

• Analyze and validate pharmacy claims using SQL and analytics tools.
• Collaborate with Finance, Legal, Product, Operations, Network, and Compliance to interpret requirements and assess outcomes.
• Develop SQL queries, reports, dashboards, and analytics tools to support claims oversight.
• Identify risks and support audits, regulatory reviews, and financial reconciliations with detailed analysis.

Skills

Advanced SQL

Healthcare analytics

Pharmacy analytics

Claims auditing

Contract compliance

Data analysis

SQL tooling

Tools

SQL

Job description

Judi Health is seeking a highly analytical Analyst to join our Analytics team and support pharmacy claims integrity, adjudication validation, and operational excellence. The role uses SQL and large-scale pharmacy data to investigate outcomes, validate pricing configurations, and ensure accurate adjudication in line with contractual and regulatory requirements.

The ideal candidate combines strong analytical and technical skills with curiosity about how pharmacy claims are processed.