Data Analyst

<p><b data-olk-copy-source="MessageBody">Must have experience on Rx claims and health insurance payer or PBM environment</b></p> <p> </p> <p><b>Rx Claims & Pharmacy Domain</b></p> <ul> <li>Analyse end-to-end Rx claims adjudication workflows, including eligibility, benefit design, formulary, pricing, accumulators, edits, prior authorization, and reversals</li> <li>Interpret and validate pharmacy benefit requirements such as copays, coinsurance, deductibles, OOP max, step therapy, quantity limits, and formulary tiers</li> <li>Support PBM integrations and data exchanges (e.g., eligibility files, claims feeds, rebates, encounter data)</li> <li>Perform root-cause analysis on claims payment issues, rejects, and member/provider escalations</li> <li>Ensure claims logic aligns with CMS, state Medicaid, and commercial regulatory requirements</li> <...