Clinical Systems Integration Analyst

Position Summary:

As a member of the Enterprise Solutions team, you will pay a critical role in contributing to the success of Capital Rx's customers leveraging Judi, our Enterprise Health Platform, to service their own pharmacy administrative needs. The enterprise solution team seeks individuals who are passionate to change the landscape of claims processing while providing superior service. This individual will hold responsibility for the setup and ongoing maintenance of formulary, utilization management, and clinical rule assets in Judi.

Position Responsibilities:

• Accountable for configuration, load, and maintenance of formulary and clinical data from previous adjudication systems into Judi.

• Provide customers with subject matter expertise in Judi's capabilities, ensuring successful migration to the adjudication platform, with parity of all clinical logic and initiatives.

• Devise a repeatable process for implementing client formulary data in Judi, establishing key milestones, and maintaining up to date project plan.

• Build and maintain trusting relationships with customers through superior customer service, meeting or exceeded service level metrics.

• Perform QA and claims testing to validate that clinical and benefits data loads yield appropriate adjudication results.

• Partner with Analytics colleagues to author automated/manual test cases and monitoring processes for drug coverage configurations and data loads.

• Reconcile adjudication output variances with support from clinical SMEs, and maintain data lineage for clinical configuration data.

• Proactively identify execution risks around build status and defects, partnering with internal Product teams and clients to surface mitigation strategies.

• Monitor performance metrics (load times, claims accuracy discrepancies) and recommend optimizations.

• Contribute to playbooks/templates that scale clinical configurations for future client onboardings.

• Take charge of critical issues or problems to key stakeholders, ensuring swift resolution and communication.

• Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends.

• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

• At least 1 year of PBM or Health Plan operations experience handling drug coverage data and adjudication configurations.

• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables.

• Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction.

• Ability to shift between competing priorities and meet organizational goals.

• Proficient in Microsoft office Suite and willing to adapt to software such as Jira, Miro, Confluence, and AWS Redshift.

• Excellent verbal, written, interpersonal and presentation skills.

• Ability to work effectively with virtual teams.

• Ability to travel 5-10%.

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.