Analyst, Data Exchange - Eligibility

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 Determined to transform an outdated model, Capital Rx’s mission is to change how prescription benefits are priced and administered in the US, unlocking enduring social change.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:

• Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols
• Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data
• Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
• Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
• Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data
• Proactively monitoring system status and eligibility 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 eligibility data integrity through regular audits and reconciliation processes
• Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor’s degree
• 1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility
• 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.