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← AffirmedRx, PBC

PBM Claims Adjudication Specialist

AffirmedRx, PBC
Location
Remote
Posted
24 days ago
Department
Data and Technology
What they actually want (must-haves)
  • Bachelor’s degree in a related field, or equivalent experience
  • Deep, hands-on experience with PBM claims adjudication
  • 7+ years of direct PBM experience building and maintaining client eligibility files and accumulator files
  • Strong knowledge of NCPDP standards, claims processing rules, and benefit design as they relate to file build and testing
  • Experience with SFTP setup, configuration, and management for secure client file transmission
  • Excellent troubleshooting and problem-solving skills
Nice to have
  • Experience working with the RxSense platform
What the job really is

The PBM Claims Adjudication Specialist at AffirmedRx is responsible for developing and maintaining client eligibility and accumulator files to ensure data accuracy. This role involves hands-on PBM claims adjudication, coding automation for file processing, and managing secure file transmissions via SFTP. The specialist will also troubleshoot data discrepancies and collaborate with team members to resolve complex client issues.

Benefits
  • Competitive compensation, including health, dental, vision and other benefits
Things to weigh
  • Remote employees must maintain a professional work environment free of distractions
  • No salary listed
Job score2.8/5
Benefits1/5
Freshness4/5
Career value4/5
Role clarity5/5
Pay transparency0/5

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