Derex Technologies Inc specializes in providing IT consulting, staffing solutions and software services. Globally headquartered in Harrison New Jersey since 1996 Derex delivers the highest quality technology professionals and an array of customized IT talent solutions designed to improve productivity and drive results to global clients throughout North America.
With over two decades of unparalleled experience, Derex provides supports to its clientele, across such industries as Systems Integration, Banking and Finance, Telecommunications, Pharmaceutical and Life Sciences, Energy, Healthcare, Technology, Transportation, and local and federal Government agencies.
Role: Data Analyst
C2H
Location: Remote. The candidate may be expected to travel to NJ office 1-2 times in a month.
Must have experience on Rx claims and health insurance payer or PBM environment
Rx Claims & Pharmacy Domain
- 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
Data Analysis & Reporting
- 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
Systems & Business Analysis
- 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, a