Pharmacy Claims Analytics Specialist

Capital Rx Inc.; Denver (CO); Hybrid; USD 122,000 - 173,000; 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. This role will use SQL and large-scale pharmacy claims data to investigate claim outcomes and ensure adjudication aligns with contracts and regulatory requirements.

The ideal candidate combines strong analytical and technical skills with curiosity for how pharmacy claims are processed, and will partner with Finance, Legal,

Qualifications

• 4-6 years of experience in healthcare analytics, pharmacy analytics, PBM operations, claims auditing, or a related field.
• Advanced SQL skills with the ability to analyze large, complex 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.
• Demonstrated ability to quantify financial exposure and communicate material findings, assumptions, and limitations to Finance, Legal, Network, Product, and executive stakeholders.

Responsibilities

• Analyze and Validate Pharmacy Claims using SQL and other analytical tools to review data and validate adjudication outcomes.
• Investigate claim pricing, benefit application, reimbursement calculations, accumulators, and other claim-processing logic to identify discrepancies or errors.
• Perform root cause analyses on adjudication issues and propose corrective actions.
• Develop monitoring and surveillance processes to identify anomalies, trends, and risks.
• Collaborate with Finance, Legal, Product, Operations, Network, and Compliance to interpret requirements and assess outcomes.
• Support audits, regulatory reviews, contractual validations, and financial reconciliations through detailed claims analysis.
• Translate technical findings into clear, actionable recommendations for business stakeholders.
• Participate in cross-functional discussions to evaluate system changes and benefit implementations.

Skills

Advanced SQL

Healthcare analytics

Pharmacy analytics

Claims auditing

Financial reconciliation

Contract compliance

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. This role will use SQL and large-scale pharmacy claims data to investigate claim outcomes and ensure adjudication aligns with contracts and regulatory requirements.

The ideal candidate combines strong analytical and technical skills with curiosity for how pharmacy claims are processed, and will partner with Finance, Legal,