Job Description :
This job ensures successful installation of all new Pharmacy clients and products as well as benefit changes to existing customers for all Sales Markets and all Lines of Business (Commercial, Senior, and ACA). Additionally, the incumbent will be responsible for escalated member and client issue resolution as it relates to the Pharmacy benefit. The incumbent will have other business operations responsibilities that include, but are not limited to: project analysis and reporting, benefit research and analysis, client benefit intent documentation and coding verification, operational support of benefit change verification with vendor, claims adjustments and refunds, client inbound and outbound transfer support, and mailing coordination with other Pharmacy stakeholders. The incumbent manages a team responsible for the daily operations of implementation activities, and monitors the entire portfolio of clients in the implementation process, addressing escalated issues requiring management involvement to overcome barriers. This role is responsible for scope management, change management, managing project resources and timelines. Client complexity will vary from mid-market clients to high complex and strategic accounts with close executive monitoring and oversight and includes support of all lines of business. Requires the highest level of teamwork, organization, attention to detail, responsiveness, and poise to excel in a fast paced, deadline-driven, multi-component complex environment. The incumbent focuses on continuous improvement in the client and product implementation process and escalated issue resolution. Provides support for Customer Service and Account Administration area in the handling and resolution of issues as well as providing support for the daily operations of the area.
- Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Manage the day to day operations of client and product installation along with member and client issue resolution as it relates to the Pharmacy benefit. This includes but is not limited to: enrollment reporting, claims adjustment and research, benefit coding research, benefit analysis, inbound/outbound client and member coordination and benefit validation/quality control for clients and product installation. Supports all markets and all LOBs (Commercial, Senior, ACA).
- Work with Sales markets and internal Pharmacy stakeholders to identify opportunities for improving the implementation process of new clients and products, sharing leading practices across regions and markets as well as addressing issues affecting the implementation of specific clients and products, escalating issues to leadership when necessary. Ensure project is successfully implemented per the requirements and agreed upon client intent.
- Ownership of Pharmacy workbook process from initiation to completion in coordination with Pharmacy stakeholders, Sales and customers. Workbook will be used to drive client benefit intent for implementation and benefit design changes.
- Drive the Organization’s Core Behaviors in all team interactions and activities. Additional responsibilities include, but are not limited to: allocating resources based upon project demand, proactively leading the identification and design of implementation process improvements. Empowered to make tactical and strategic decisions and is accountable for all activities performed by the team.
- Monitor the performance of Client Installation and Operations team members, drive accountability in direct reports and provide guidance on strategies to maintain or improve performance.
- Other duties as assigned or requested.
- Bachelor’s Degree in Business Administration or related field
- 3 years in business operations
- 3 years in a leadership role
- 3 years of data analysis OR project management
- 3 years of cross-functional projects
- 3 years in the Healthcare industry
LICENSES or CERTIFICATIONS
- Issue Resolution and Problem-Solving
- Microsoft (Excel, Word, Powerpoint, Access)
- Detail Oriented
- Project Management
- Product Implementation
- Sales Support Administration and Implementation
Language (Other than English):
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Referral – Level 2
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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