Review, analyze, and reconcile pharmacy claims and payments data.
Configure vendors for payment processing in our financial system.
Verify and ensure that all vendors possess all required credentials.
Ensure accurate and timely processing of pharmacy, member, and provider payments and remittances.
Collaborate with pharmacy network partners to resolve payment-related inquiries.
Investigate and resolve payment discrepancies and variances.
Develop and maintain strong relationships with pharmacies, providers, and reconciliation companies.
Prepare and distribute paper or electronic (835) remittances and reports.
Manage the reissuance of checks for voided or reprocessed payments.
Monitor and report on key performance indicators related to payment accuracy and timeliness.
Ensure compliance with state regulations by submitting unclaimed funds to the state.
Participate in the development and implementation of financial policies and procedures.
Assist in financial audits and provide documentation as needed.
Stay up to date with industry standards and compliance requirements.
Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
Write SQL queries to retrieve specific Pharmacy files from the data warehouse as needed.
Respond to internal and external inquiries regarding payment data, providing clear and actionable insights.

Requirements

Bachelor’s degree in accounting, Finance, Data Science, or a related field (or equivalent relevant work experience).
2+ years of experience in PBM with exposure to claims, payments, and remittances.
Strong SQL proficiency is required, including ability to write queries and perform data validation.
High proficiency in Microsoft Excel, including advanced functions, pivot tables, lookups, and data accuracy checks.
Python knowledge is a plus but not required for this role.
Strong analytical and problem-solving skills.
Exceptional attention to detail, especially in data checks, reconciliations, and validation steps.
Excellent communication and interpersonal skills.
Ability to work independently and collaboratively in cross‑functional teams.
Knowledge of healthcare compliance regulations is a plus.
Nice to have: Experience with Sage software for managing payment processes and financial reconciliations.

Benefits

Health insurance
401(k) matching
Flexible working hours
Paid time off
Professional development opportunities

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLMicrosoft Exceldata validationdata reconciliationpayment processingfinancial auditingreport preparationclaims analysispayment discrepancies resolutionfinancial policy development

Soft Skills

analytical skillsproblem-solving skillsattention to detailcommunication skillsinterpersonal skillsindependent workcollaborative workrelationship managementinquiry responseactionable insights