About The Position
Bluespine is an innovative new startup on a mission to transform healthcare spending for self-insured employers. By employing cutting-edge technologies, we identify overbilling in paid medical and pharma claims, which causes billions of dollars in losses across the entire industry. Bluespine can offer personalized precision by validating claims at scale against employer’s unique plans, policies, and contracts, ensuring unparalleled accuracy.
We are looking for a passionate individual to lead and shape the prescription drug claim audits practice and support engineering and data science teams as a subject matter expert as we grow and improve our technology.
Responsibilities
- Lead and conduct prescription drug claim audits, on behalf of the plan sponsor, to ensure accuracy and compliance with contractual obligations, regulatory standards, and formulary terms. This includes the entire audit cycle from scope definition to final report and presenting the findings.
- Review customers’ (employers) PBM contracts and plan documents and identify what can be tested and how. Validate algorithmic results and provide feedback to help tune them.
- Utilize data analysis techniques and company’s systems to develop and validate new concepts, and identify potential instances of fraud, waste, and abuse.
- Support engineering and data science teams with prescription drug claim audit concepts, data mapping, and defining data requirements.