ValueMomentum · 14 hours ago
Data Analyst
Piscataway, NJ
Contract
Onsite
Senior Level
5+ years expValueMomentum is a company focused on healthcare solutions, and they are seeking a Data Analyst. The role involves analyzing Rx claims workflows, validating pharmacy benefit requirements, and supporting PBM integrations while ensuring compliance with regulatory requirements.
FinanceHealthcareSoftwareProperty & Casualty InsuranceFinancial ServicesHealth CareInsurTech
Hiring Manager
Sowmya Kalikota
Responsibilities
Analyse end-to-end Rx claims adjudication workflows , including eligibility, benefit design, formulary, pricing, accumulators, edits, prior authorization, and reversals
Interpret and validate pharmacy benefit requirements such as copays, coinsurance, deductibles, OOP max, step therapy, quantity limits, and formulary tiers
Support PBM integrations and data exchanges (e.g., eligibility files, claims feeds, rebates, encounter data)
Perform root-cause analysis on claims payment issues, rejects, and member/provider escalations
Ensure claims logic aligns with CMS, state Medicaid, and commercial regulatory requirements
Query and analyze large Rx claims datasets using SQL and analytical tools to identify trends, anomalies, and financial impacts
Develop and maintain operational, financial, and compliance reports related to pharmacy utilization, spend, and claims accuracy
Support audits, reconciliations, and compliance reporting (e.g., CMS encounters, PDEs, state reporting)
Validate data accuracy across upstream and downstream systems
Gather and document business requirements and translate them into functional specifications, data mappings, and system rules
Partner with IT and vendors to support system enhancements, benefit changes, releases, and production issue resolution
Participate in UAT planning and execution , including test case creation, test data validation, and defect triage
Support modernization initiatives, including claims platform upgrades, PBM transitions, and data integrations
Act as a liaison between Pharmacy Operations, IT, Finance, Compliance, and vendors
Communicate complex pharmacy and claims concepts clearly to technical and non-technical stakeholders
Qualification
Required
5+ years of experience as a Data Analyst, Systems Analyst, or Business Analyst in a health insurance payer or PBM environment
Strong hands-on experience with Rx claims data and pharmacy benefit management
Advanced proficiency in SQL and experience working with large healthcare datasets
Solid understanding of pharmacy benefit design, claims adjudication logic, and payer operations
Experience supporting production issues, audits, and regulatory reporting
Excellent communication skills with the ability to work across technical and business teams
Preferred
Experience with Rx claims platforms (e.g., Facets Rx, QNXT, RxClaim, MedImpact, Caremark, OptumRx)
Familiarity with CMS Part D, Medicaid pharmacy programs, and encounter/PDE reporting
Company
ValueMomentum
ValueMomentum provides Software & Services to Insurance, Healthcare & Financial Services firms.
1001-5000 employees
H1B Sponsorship
ValueMomentum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (149)
2024 (168)
2023 (141)
2022 (183)
2021 (230)
2020 (160)
Funding
Current Stage
Late StageLeadership Team
G
Gopi Mani Raju RAJ Samanthapudi
Founder and Executive Chairman
Recent News
2025-09-17
2025-05-17
Company data provided by crunchbase