Sr. Analyst, Adjudication

Being on medication is tough enough. We want to make getting it the easy part. Getting prescriptions to patients has become increasingly complex. When things get messy along the prescription journey, pharmaceutical manufacturers rely on us to untangle the process and create a clear path—allowing patients to build trusting relationships with their medication brands.

We’re not only committed to taking the pain out of the prescription process, but we’re also devoted to bringing the brightest minds together under one roof. We bring together diverse voices—engineers, pharmacists, customer service veterans, developers, program strategists and more—all with one vision. Each perspective and experience makes ConnectiveRx better than the sum of its parts.

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading complex technical work and influencing how adjudication solutions are designed, implemented, and supported. This role partners with various internal stakeholders, external adjudication vendors and clients to translate business requirements into scalable adjudication solutions and analyzes and recommends business rule options to meet clients’ program needs. The Sr Analyst architects solution approaches, validates system functionality, leads root-cause investigations, performs impact assessments, mentors Adjudication Analysts, drives documentation, governance, and continuous process improvement, and serves as an escalation point for complex adjudication questions to help ensure accuracy, stability, and compliance of affordability programs. 

• Architect adjudication solutions, interpret business requirements, author technical specifications, and coordinate implementation with external adjudicators.
• Lead complex root-cause investigations, transaction research, and issue resolution using transaction and program-level data.
• Partner with internal and external stakeholders during solution design, testing, implementations, and program enhancements.
• Drive technical documentation, governance, process improvements, work instructions, automation opportunities, developments, and continuous improvement initiatives.
• Serve as a mentor and escalation point by coaching Adjudication Analysts, reviewing technical work, sharing knowledge, and supporting complex adjudication questions.
• Other responsibilities as needed: Conduct adjudication training sessions for internal teams and Adjudication Analysts. Support audits and client inquiries. Review technical designs and peer work products to validate implementation accuracy and support consistent solution design. Support major client implementations, conversions, product launches, and complex escalations. Recommend strategic enhancements to improve operational efficiency, governance, documentation quality, and program outcomes.

Education/Degree Requirements/Certifications

• Bachelor's degree or 6 years' of experience required.

Experience

• 5+ years supporting pharmaceutical affordability or claims adjudication programs, with demonstrated experience leading complex technical initiatives.

Knowledge

• Advanced knowledge of pharmaceutical affordability programs and adjudication workflows.
• Strong understanding of solution architecture, business rule interpretation, and client program design needs.
• Knowledge of NCPDP claims processing, transaction analysis, and technical documentation requirements.
• Understanding of governance, compliance expectations, and operational controls supporting affordability programs.

Skills

• Advanced analytical, troubleshooting, and root-cause analysis skills.
• Strong technical specification development, implementation validation, and peer review skills.
• Ability to mentor analysts, share knowledge, and support complex adjudication questions.
• Proficiency with Microsoft Office and reporting tools where applicable.
• Expert understanding and ability to navigate adjudicators' claims processing system and other software as necessary.
• Advanced ability to listen actively and effective written and verbal communications skills for conveying findings, issues, and recommendations.
• Understands the need to share only relevant information.
• Ability to adapt to different audiences, ensuring that the message is clearly articulated.

Competencies

Communication (Oral & Written)

Ability to listen actively and communicate key issues respectfully. Understand the need to share only relevant information. Ability to adapt to different audiences, ensuring that the message is clearly articulated.

Service Orientation

Anticipate, identify, and address the needs of customers/clients, sometimes before those needs are voiced. Actively looks for ways to help people; ability to be thoughtful, empathetic to the needs of others. Is prompt and courteous in ensuring that the customer's immediate needs or complaints are satisfied. Focuses on improving the level of service provided to external and internal customers.

Technical Utilization

Utilizes the technical knowledge and abilities required in the specialist and professional job function to accomplish the desired outcomes. Demonstrates technical proficiency within the scope of responsibilities. Understands the technical difficulty and complexity of the activity and provides appropriate advice to others. Ability to improve or redesign processes by utilizing technical solutions. Ability to comprehend and perform basic arithmetic.

Travel or Physical Requirements

• Occasional travel may be required to company offices, client sites, or external adjudication vendor locations.

Compliance Requirements

• Adhere to all Company Policies, Procedures, and other training consistent with ConnectiveRx's Information Security and Compliance Programs, including but not limited to the following compliances and regulations: SOC1, SOC2, PCI, HIPAA.
• Maintain strict compliance with company and client policies regarding business rules and ethics, as well as applicable local, state and national federal laws.