Analyst, Adjudication

ConnectiveRx

. Assist in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings .

Posted 11/4/2026full-timeRemote • New Jersey • United StatesJuniorMid-Level💰 $55,000 - $71,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in adjudication processes and quality control methodologies, with strong analytical skills for data interpretation and issue investigation. Proficient in Salesforce and Microsoft Office, with a focus on maintaining operational standards and effective communication.

Highest-signal resume keywords

Adjudication Claims ProcessingQuality Control MethodologiesSalesforce ProficiencyAnalytical Problem-Solving SkillsPharmacy Technician Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality Control ReviewsOperational AnalysisData AnalysisRoot-Cause AnalysisDocumentation MaintenanceBusiness Rule InterpretationInvestigative WorkClaims Processing KnowledgeSOP MaintenanceSpreadsheet Management

Soft Skills

Attention to DetailEffective CommunicationOrganizational SkillsMultitaskingTeam Collaboration

Tools & Technologies

SalesforceManageEngineCRx SystemsMicrosoft Office

Industry Keywords

Healthcare OperationsPharmaceutical Affordability ProgramsRules-Driven EnvironmentsOperational StandardsAdjudication Data

About the role

Key responsibilities & impact

Assist in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings
Respond to and resolve business rule questions or concerns escalated by internal teams or adjudicator partners, escalating complex issues as appropriate
Conduct quality control reviews on new program setups and requested updates
Access, analyze, and interpret program and adjudication data to evaluate rule functionality
Investigate discrepancies, anomalies, or incorrect outcomes and document findings
Develop and maintain working knowledge of adjudication claims engines and networks, including differences in system logic across multiple adjudicators
Work proficiently within Salesforce, ManageEngine, and CRx systems
Support documentation updates and process improvements
Maintain SOPs, work instructions, job aids, tracking logs, and spreadsheets
Participate in regularly scheduled adjudication calls, ad hoc meetings, internal discussions, and required training sessions

Requirements

What you’ll need

Bachelor’s degree from 4-year college or university or equivalent experience required
Minimum 2-4 yrs of pharmacy technician/adjudication experience
Prior experience performing quality checks, operational analysis, or investigative work preferred
Knowledge of healthcare operations claims processing, pharmaceutical affordability programs, or other rules-driven operational environments
Understanding of quality control methodologies, issue investigation, and root-cause analysis
Familiarity with interpreting, applying, and questioning documented business rules
Awareness of operational standards and documentation
Intermediate skill level in Microsoft Office applications
Proficient analytical and problem-solving skills with the ability to conduct independent investigations
Ability to research by gathering information, identifying patterns, establishing relationships between data points, and drawing logical conclusions based on data
Excellent attention to detail and accuracy in data analysis, quality checks, and documentation
Proficient ability to listen actively and effective written and verbal communication skills
Ability to share only relevant information
Ability to adapt to different audiences and clearly articulate messages
Detail-oriented, analytical, organized, multitasking, time management, and quick-learning capabilities
Ability to work accurately and collaboratively both independently and as part of a team
Must be willing to travel to CRx offices when needed as requested by supervisor
Must be willing to travel to adjudicator locations when necessary

Benefits

Comp & perks

Opportunities for a bonus (or commissions)
Medical, dental, vision, life, and disability insurance
401(k) plan, with employer contributions where applicable
Flexible paid time off (PTO) policy for exempt employees, covering sick days, personal days, and vacations
Eight standard company holidays annually
Three floating holidays annually