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Rx Claims SME

Job

Spectraforce

Remote

Full-Time

Posted 4 weeks ago (Updated 3 weeks ago) • Actively hiring

Expires 7/18/2026

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Job Description

Job Title:
Rx Claims SME Location:
Eden Prairie, MN 55344 (Hybrid)
Duration:
12 months
Job Description:
In depth knowledge on RxClaim Adjudication, claims processing, MedD claims Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR)Knowledge on business & plan configuration and plan option knowledge. Facilitate discussion with Product Owners, Business and clarify business requirements High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.
Experience:
10 Years of Relevant Experience.