Analyst, Data Exchange - Claims Operations

Location: Remote

About Capital Rx

Capital Rx is a next-generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change how prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology, and service is why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

• Work with Data Exchange partners and internal teams to develop and maintain Data Exchange data feeds (ex. claims, vaccine reimbursements, eligibility, etc.) and ensure their accuracy at Capital Rx
• Serving as a point of coordination for Data Exchange identification and issue resolution with internal teams and external integration partners
• Identify and triage Data Exchange issues and support the resolution of all errors related to transferring, loading, and management of integrated Data Exchange data
• Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy
• Ensuring that all issues and errors are resolved using designated operating standards and within defined service levels
• Assist with the validation of Data Exchange data integrity through regular audits and reconciliation processes
• Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests

Required Qualifications:

• Bachelor’s degree
• 1+ years of previous work experience, preferably in Data Exchange, Healthcare, PBM, or IT
• Ability to match key PBM concepts and data fields across various systems and file layouts to ensure consistency and accuracy of data transfers
• Ability to analyze complex business problems to discover and resolve root causes
• Proficiency in SQL, Excel, JSON and other technical data skills preferred
• Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
• Self-motivated and detail-oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Base: $85,000 - $110,000

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.