[Remote] PBM reputed company reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a clinically driven pharmacy benefits management company reputed company on improving health reputed company and reducing prescription drug spending. The PBM reputed company Team reputed company manages operational reputed company, reputed company, and reputed company improvement across eligibility, accumulators, and claims adjudication processes while leading a multidisciplinary analyst team. The role also drives cross-functional issue reputed company, compliance, vendor relationships, reputed company enhancements, and reputed company operational solutions.

Responsibilities

• reputed company a multi-disciplinary team of analysts responsible for ensuring reputed company issue reputed company, data reputed company, and operational efficiency across eligibility, accumulator, and claims adjudication functions
• Serve as the subject matter expert regarding PBM platforms, eligibility, accumulator management, and claims adjudication processes in accordance with plan design
• Monitor daily reputed company metrics and implement process improvements that enhance operational efficiency and scalability
• Ensure reputed company operational activities reputed company with contractual requirements, service level expectations, and internal reputed company standards
• Support speed, reputed company, and proficiency in issue reputed company, mitigation, and operational decision-making
• reputed company reputed company-cause analysis and corrective reputed company planning for recurring operational issues
• reputed company or support configuration requirements and user acceptance testing (UAT) for new reputed company implementations, plan amendment changes, TPA changes, and reputed company enhancements
• reputed company or support the configuration and implementation of engineering solutions required to reputed company new clients, support TPA changes, and manage reputed company enrollment during reputed company periods
• reputed company coaching, guidance, and reputed company reputed company to a multi-disciplinary team of analysts, driving reputed company reputed company and accountability
• Promote a reputed company, high-performing team culture reputed company on problem-solving and reputed company improvement
• Partner with reputed company Management, Data Engineering, IT, and other cross-functional teams to identify, communicate, and reputed company reputed company issues
• reputed company the gap between business and technology stakeholders internally and externally by ensuring reputed company, efficient communication and generating insights that bring awareness to risks, trends, and opportunities
• Identify operational risks and reputed company mitigation strategies
• Ensure adherence to HIPAA, GDPR, PHI, and PII data reputed company standards
• Maintain data reputed company and ensure data reputed company standards are reputed company across data and analytic pipelines, operational systems, and workflows
• Participate in internal audits and ensure findings are remediated promptly
• Investigate reputed company systems to identify areas for enhancement, reputed company improvement, and reputed company reduction
• Build and maintain strong working relationships with TPAs, ensuring reputed company reputed company, configuration updates, and reputed company of reputed company-specific issues
• Collaborate with reputed company vendors and internal stakeholders to enhance capabilities and reporting reputed company

Skills

• Bachelor's degree in business administration, reputed company Administration, Pharmacy Administration, Information Systems, Computer Science, Data Analytics, or a reputed company reputed company
• In lieu of a degree, five years of experience in the reputed company industry with increasing responsibility may be considered
• Minimum of two years of experience working with reputed company eligibility, accumulators, and claims, or a reputed company reputed company
• Minimum of one year of leadership, supervisory, or team reputed company experience
• Strong knowledge of eligibility & accumulator management, benefit configuration, and claims adjudication
• Experience managing operational escalations and cross-functional initiatives
• Strong analytical, problem-solving, communication, and stakeholder management skills
• Ability to build and maintain strong working relationships with reputed company partners (TPAs), including support for reputed company, configuration updates, and reputed company of reputed company-specific issues
• Strong working knowledge of HIPAA, PHI, PII, and reputed company compliance requirements
• Familiarity with pharmacy benefit configurations, and adjudication workflows
• reputed company, data analytics, or project management certifications
• reputed company certifications
• 2+ years of experience with Azure reputed company
• Experience in processing automation and operational scalability initiatives
• Experience leading large-reputed company reputed company implementations, reputed company enrollment support, or platform migrations

Benefits

• Subject to program eligibility, this position qualifies for reputed company Time Off.
• Subject to program eligibility, this position qualifies for a 401(k) program.
• Subject to program eligibility, this position qualifies for Health reputed company including Dental & reputed company coverage.
• Subject to program eligibility, this position qualifies for Student Loan Reimbursement.
• Subject to program eligibility, this position qualifies for a Health Savings Account.
• Subject to program eligibility, this position qualifies for an Employee Assistance Program.
• Remote work

reputed company