Description:
• Research and analyze pharmacy claims to verify accuracy and contractual compliance across benefit setup, pricing, and guarantees
• Perform audit risk assessments, annual logic reviews, and ongoing monitoring activities
• Analyze, reconcile, and validate large datasets across multiple internal systems
• Develop and maintain SQL and Python queries for audit reporting and performance monitoring
• Create audit deliverable reports, quantify financial impact of potential and confirmed findings, and build dashboards to identify trends and risks
• Identify and implement automation and process improvements across audit, reporting, and reconciliation workflows
• Maintain and enhance code, reporting tools, and dashboards to improve reliability, efficiency, and scalability
• Define and document technical requirements, data specifications, and methodologies to support transparency and repeatability
• Collaborate with internal and technology teams to improve data quality, workflows, and controls, and provide ad-hoc analysis to support evolving business and audit needs
• Ensure adherence to the Capital Rx Code of Conduct, including reporting noncompliance
Requirements:
• Bachelor’s degree in a quantitative or business-related field (e.g., Actuarial Science, Statistics, Economics, Finance, Data Analytics, Business Administration)
• 2+ years of experience in data analytics, audit, or a related role
• Experience in healthcare, PBM, or pharmacy claims; knowledge of pharmacy benefits, pricing, guarantees, and pharmacy claims analysis preferred
• Proficiency with SQL (Snowflake preferred), Excel, and Tableau
• Familiarity with Python and project management/version control tools (e.g., Jira, Confluence, GitHub)
• Experience with audit testing, internal controls, risk assessment, and reconciling large datasets
• Track record of leading cross-functional initiatives, meeting deadlines, and executing on deliverables
• Strong attention to detail, intellectual curiosity, passion for continuous improvement, and ability to shift priorities and stay highly organized
• Effective verbal and written communication with both technical and non-technical stakeholders
Benefits:
• Salary range: $80,000 — $100,000 USD
• Opportunity to work on Judi’s enterprise health platform and with Capital Rx to impact pharmacy benefits and claims processes
• Company commitment to a diverse workplace and equal employment opportunities
• Flexible position description allowing management to assign or reassign duties to meet organizational goals