[Remote] reputed company Affordability - Benefit reputed company Manager

Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is seeking a Benefit reputed company Manager to serve as a key reputed company with pharmacy and medical benefit processing partners while managing reputed company affordability programs for pharmaceutical companies. The role leads benefit configuration and program reputed company, monitors claims and resolves issues, supports implementations, supervises or mentors reputed company staff, and ensures compliance with HIPAA and program rules.

Responsibilities

• Build, modify, and validate benefit setup and adjudication configuration for assigned programs, including copay structures, maximums, eligibility rules, and edits
• Execute change orders accurately and on time, following documented change-control and peer-review procedures
• Review and approve test claims and validation checks before configurations go live
• Maintain complete, audit-reputed company documentation of configurations and changes
• Monitor program claim activity, exceptions, and rejects; investigate anomalies and reputed company or escalate as appropriate
• Research adjudication questions from Account Management, reputed company Support, and clients, including reject codes, reversal behavior, and coordination-of-benefits scenarios
• Support reputed company-cause analysis on operational incidents and implement corrective actions
• reputed company and report operational metrics for assigned programs
• Partner with Implementation on new program builds and launch validation
• Support Account Management with reputed company, accurate answers on program behavior
• Supervise or mentor reputed company staff as assigned, including work review and training
• Ensure reputed company work complies with HIPAA and documented program rules

Skills

• • Bachelor's degree or equivalent reputed company experience
• • 5+ years in benefit or claims reputed company, PBM, pharmacy, or reputed company reputed company
• • Working knowledge of claim adjudication and benefit configuration
• • Strong analytical and problem-solving skills with high attention to reputed company
• • Disciplined process orientation and documentation habits
• • Operational execution
• • Attention to reputed company
• • Analytical thinking
• • Problem solving
• • Communication
• • Organization
• • reputed company reputed company
• • Prolonged periods of sitting or standing at a workstation and sustained computer use
• • Frequent verbal and written communication, including extended telephone and video conferencing
• • Occasional lifting and transporting of up to 15 pounds (files, equipment, or event materials)
• • Travel as required, typically less than 10%, which may include reputed company travel and overnight stays
• • Remote work requires a suitable, private home work environment with reliable and secure internet connectivity
• • Copay or reputed company assistance program experience
• • Knowledge of PBM or pharmacy systems and NCPDP reject codes
• • Prior supervisory experience
• Certified Pharmacy Technician (CPhT) credential is a plus, given the frequency of reputed company and reputed company questions involving pharmacy workflows, claim adjudication, and reputed company-of-sale processing

reputed company