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Lead Pharmacy Payment Integrity Analyst

June 2, 2026

Position Overview: The Pharmacy Payment Integrity Analyst plays a critical role in analyzing and interpreting Pharmacy data to provide actionable insights for improving patient outcomes, optimizing clinical workflows, and supporting healthcare decision-making. This position ensures accurate claims processing, policy interpretation, and regulatory alignment to prevent overpayments and cost-effective healthcare payments. What you’ll drive: <ul><li>You’ll identify, waste and inaccurate Pharmacy claims </li></ul><ul><li>You’ll work with industry leading AI, predictive analytics, and automation platforms to uncover patterns and drive smarter decisions. </li></ul><ul><li>You’ll foster a culture of learning, refinement, and ethical excellence to create high quality, evidence-backed referrals that reduce health insurance costs. </li></ul>What you’ll do: <ul><li>Identify Pharmacy billing activities leading to improper payments. This work involves reviewing Pharmacy claims, insured members, or the broker community in coordination with the customer’s carrier or third-party administrator </li></ul><ul><li>Review claims data and conduct analysis to look for patterns of potential improper payments </li></ul><ul><li>Utilizing information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels </li></ul><ul><li>Conduct data analysis to review claim and case history </li></ul><ul><li>Reviews claims history, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc. </li></ul><ul><li>Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets </li></ul>What you bring: <ul><li>Bachelor's degree or 4 – 6 years of equivalent work experience in healthcare administration, billing, Pharmacy claims adjudication, Pharmacy auditing, payment integrity operations and/or healthcare reimbursement, </li></ul><ul><li>CPhT, CPC, CCS or other relevant clinical/Pharmacy/coding certifications strongly preferred. </li></ul><ul><li>Strong knowledge of clinical terminology, medical procedures, Pharmacy and healthcare workflows </li></ul><ul><li>Ability to be concise, independent and provide defensible decisions in writing </li></ul><ul><li>Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills </li></ul><ul><li>Strong critical-thinking, communication and attention to detail skills </li></ul>Bonus points for: <ul><li>An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (commercial health plans and/or dental plans) </li></ul><ul><li>3+ years of experience working in the group health business with pharmacy as an emphasis </li></ul><ul><li>Experience in the healthcare industry, clinical research or working clinical trials </li></ul>How to be successful in this role: <ul><li>Analytical Skills: Strong ability to interpret complex data and derive meaningful insights to drive healthcare outcomes </li></ul><ul><li>Problem- Solving: Ability to identify issues in datasets and clinical workflows and suggest data-driven solutions </li></ul><ul><li>Attention to Detail: High level of precision and accuracy in handling critical data </li></ul>Who is SmartLight Analytics SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce the wasteful spend in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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