Analyst, Pharmacy Financial Operations

Position Summary:

The Analyst, Finance Operations position is a hands-on position responsible for managing the day-to-day operations and activities of the finance team. The Analyst, Pharmacy Financial Operations should be highly motivated, have a positive team attitude, and support the overall organization.

Position Responsibilities:

• 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.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:

• 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.