Claims Operations Analyst

Who we are: SmithRx is a rapidly growing, venture-backed Health-Tech company.  Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting-edge technology, innovative cost-saving tools, and best-in-class customer service.  With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country. We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our Company values of: Integrity: Do the right thing. Especially when it’s hard. Courage: Embrace the challenge. Together: Build bridges and lift up your colleagues Job Summary: As a Claims Operations Analyst, you will be responsible for supporting the Plan Operations team with daily activities that support behind the scenes activities related to claims processing, mass member communications, implementation activities, and other technical responsibilities. You will play a supporting role within the Plan Operations in performing claims analysis for groups in transition to SmithRx and the downstream communications to members related to potential disruptions. What will you do: Administer process for non-processed prescription claims including: Commercial out-of-network claims processing Direct member reimbursement claims Secondary payer claims Worker’s compensation out-of-network claims payment and negotiation Ensure claims approvals and/or denials are made in accordance with company practices and procedures Timely execute on member communications at scale, including mail-outs through our third-party mail vendor Claims analysis to support member disruption analysis Support implementation activities related to claims management Be accountable for ensuring timely complementation of non-electronically processed claims What will you bring to SmithRx: Bachelor’s degree or equivalent work experience At least 2-5 years of claims processing, medical billing, healthcare benefits, pharmacy benefits, and/ or commercial health insurance experience required Pharmacy Technician license preferred Advanced skills in Microsoft Excel required Moderate proficiency in SQL required Robust problem-solving and analytical skills Impeccable attention to detail and accuracy in work product Strong organizational, problem-solving, written and verbal communication, and interpersonal skills Ability to work independently as well as part of an extended, cross-functional team Self-driven, results-oriented work ethic with a positive outlook Ability to take the initiative with little to no direction Remote candidates will be considered.  What SmithRx Offers You:  Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, Life insurance  Flexible Spending Benefits  Discretionary Time Off  401(k) Retirement Savings Program  Paid Parental Leave benefits Professional development and training opportunities