Research and analyze pharmacy claims to ensure 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/Python queries for audit reporting and performance monitoring
Create audit deliverable reporting, quantify financial impact of potential and confirmed audit 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
Provide ad-hoc analysis to support evolving business and audit needs
Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Requirements

Bachelor’s degree in a quantitative or business-related field (e.g., Actuarial Science, Statistics, Economics, Finance, Data Analytics, or 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, Tableau
Familiarity with Python and project management/version control tools (e.g., Jira, Confluence, GitHub)
Strong attention to detail with an intellectual and professional curiosity along with a passion for continuous improvement
Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
Effective communicator with both technical and non-technical stakeholders
Extremely flexible, highly organized, and able to shift priorities easily

Benefits

Health insurance
Retirement plans
Paid time off
Flexible work arrangements
Professional development

Applicant Tracking System Keywords

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

Hard Skills & Tools

SQLPythondata analyticsauditdata reconciliationdata validationfinancial impact analysisautomationprocess improvementdata specifications

Soft Skills

attention to detailintellectual curiosityprofessional curiositycontinuous improvementleadershiphigh performancedeadline managementeffective communicationorganizational skillsflexibility