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Prescryptive Health, Inc.Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in advanced SQL for data validation and investigation, along with extensive experience in managing pharmacy claims processing and integrations. Capable of leading cross-functional teams and communicating effectively with both technical and non-technical stakeholders.
Highest-signal resume keywords
Advanced SQL ProficiencyPharmacy Claims Processing ExperienceData Architecture DesignIntegration Testing CoordinationCloud Experience in Microsoft Azure
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Profile, map, and validate complex claims, eligibility, accumulator, and encounter data across multiple sources.
- Resolve daily eligibility and accumulator discrepancies arising from file imports and monthly reconciliations.
- Write and execute advanced SQL for investigation, validation, regression testing, and special data loads.
- Lead cross-functional root-cause investigation and remediation of production issues.
- Anticipate system and data failures before they happen.
- Partner with engineering and architects on scalable, compliant integration architecture for claims, eligibility, and accumulators.
- Own end-to-end delivery of benefit data integrations, including timelines, milestones, risks, dependencies, and executive reporting.
- Coordinate with external vendors and internal engineering, translating vendor data formats and constraints for engineering and vice versa.
- Plan and coordinate integration testing, UAT, and implementation readiness, including data migration, rollback planning, and post-deployment support.
- Communicate findings and recommendations to technical and non-technical stakeholders.
- Maintain system documentation and operational procedures.
- Direct teams handling day-to-day integration work.
Requirements
What you’ll need- Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative field.
- At least 10 years of hands-on technical experience with data systems, SQL, and integrations.
- At least 6 years of direct PBM or pharmacy claims processing experience, including deep knowledge of benefit configuration, adjudication logic, eligibility, and accumulator integrations.
- Advanced SQL proficiency, including complex querying and data investigation.
- Experience supporting eligibility and accumulator reconciliation processes.
- Experience designing scalable data architecture for healthcare data systems.
- Experience managing delivery timelines, risks, and dependencies, and coordinating integration testing and UAT.
- Working knowledge of the ANSI/NCPDP Telecommunication Standard and PBM or TPA claims processing.
- Hands-on experience with ETL, secure file transfer (SFTP/PGP), and job scheduling and alerting tools.
- Experience with a pharmacy benefits adjudication platform.
- Cloud experience, ideally Microsoft Azure, in healthcare data environments.
- Familiarity with C#, Java, JavaScript, Python, or R.
Benefits
Comp & perks- The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry.
- Flexible time off, including 12 paid holidays.
- 401k match plus 100% employer-provided medical, dental, and vision premiums.
- Company contribution to Health Savings Account.
- Stock options.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Advanced SQLData ValidationData InvestigationEligibility ReconciliationAccumulator ReconciliationBenefit ConfigurationAdjudication LogicETLData MigrationJob Scheduling
Soft Skills
CommunicationLeadershipProblem-SolvingCollaboration
Tools & Technologies
SFTPPGPPharmacy Benefits Adjudication PlatformANSI/NCPDP Telecommunication Standard
Industry Keywords
Healthcare Data SystemsPBMTPA Claims ProcessingQuantitative Field