Rx Claims SME

TechDigital Group; Eden Prairie (MN); On-site; USD 60,000 - 80,000; Full time

Job summary

TechDigital Group, located in Eden Prairie, Minnesota, is seeking a skilled professional with in-depth knowledge on RxClaim Adjudication and claims processing. The ideal candidate will have a strong understanding of PBM concepts, including drug pricing and copays, and be proficient in managing data validation.

This role involves facilitating discussions with Product Owners and clarifying business requirements. The candidate should possess high-level knowledge in executing root cause analysis and navigating automated database systems.

Qualifications

• In depth knowledge on RxClaim Adjudication and claims processing.
• Deep knowledge of PBM concepts including drug pricing and copays.
• Ability to facilitate discussions and clarify business requirements.

Responsibilities

• Manage data validation and conduct root cause analysis.
• Navigate automated database systems and reporting tools.

Job description

JD:

• In depth knowledge on RxClaim Adjudication, claims processing, MedD claims
• Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR)
• Knowledge on business & plan configuration and plan option knowledge.
• Facilitate discussion with Product Owners, Business and clarify business requirements
• High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.