Manage team members in benefit configuration and testing.
Improve processes and institute best practices in benefit configuration.
Build and maintain pharmacy benefit plans for client groups.
SmithRx is a rapidly growing Health-Tech company disrupting the Pharmacy Benefit Management (PBM) sector. They focus on building a next-generation drug acquisition platform with technology, cost-saving tools, and customer service, fostering a mission-driven and collaborative culture.
Analyze benefit plan documents to accurately build benefit categories and adjudication rules.
Be a leader on the configuration team by supporting training, process development, and peer review / QA.
Support cross-functional teams during implementations/renewals and develop solutions for plan variations.
Gravie aims to improve healthcare access through consumer-centric health benefit solutions. They foster a diverse and authentic work environment where individuals can contribute uniquely to industry-changing products and services.
Support implementation and client management teams with all day-to-day client requirements
Responsible for timely and accurate management and execution of all client benefit requests
Analyze incoming client requests and work with internal and external teams to complete required plan documentation
Judi Health is an enterprise health technology company providing solutions for employers and health plans, including pharmacy benefit management and health benefit management solutions. They focus on rebuilding trust in healthcare. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table.
Review and audit medical claims for accuracy and compliance.
Listen to customer service phone calls for accuracy and professionalism.
Prepare reports on audit findings and recommendations for process enhancements.
Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They focus on cost containment strategies with innovative solutions. The posting does not specify the number of employees or further details about the culture.
Develop and implement programs that benefit clients.
Manage pharmacy service provider relationships.
EPIC is a company with over 60 offices and 3,000 employees nationwide which embraces diversity in all its various forms. They foster a work community where every colleague feels welcomed, valued, respected and heard, believing that diversity drives innovation.
Guide healthcare providers through the reimbursement process, including prior authorizations and appeals.
Work with insurance companies and third-party administrators to address coverage issues.
Provide education regarding insurance benefits and financial assistance programs.
Amplity is a full-service go-to partner of biopharma companies that delivers flexible + specialized medical + commercial services. Amplity transforms how breakthrough treatments reach the people who need them with expert-led teams delivering contract medical, commercial + communications excellence for 40+ years.
Independently manage the day-to-day administration of benefit plans, including medical, dental, vision, and 401(k), ensuring data integrity across all systems.
Partner with our leave administrator, Unum, to manage end-to-end LOA processes, including FMLA, state leaves, ADA accommodations, and company leave programs; ensure compliance, accurate tracking, and a seamless employee experience.
Resolve routine benefit issues for employees with empathy and urgency, elevating the consumer experience for our own team members.
Hims & Hers is a health and wellness platform committed to helping individuals feel their best through improved health. They focus on customer-centric, affordable, and personalized care, and is a public company traded on the NYSE under the ticker symbol “HIMS”.
Responsible for being the main point of contact for TPA (an external client) for new group implementations.
Ensure all requirements are documented in the standard project templates and tools.
Manage day to day coordination and task managements for a pod of Implementation Managers and/or Implementation Specialists to maintain workplace productivity.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the Pharmacy Benefit Management (PBM) sector. They accomplish this through technology and customer service, with a mission-driven and collaborative culture that inspires employees.
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
Own end-to-end program management for supplemental benefit implementations.
Lead vendor management across multiple benefit categories, serving as the primary point of accountability for vendor performance and delivery.
Drive large, complex implementations by coordinating across Plan Product, Operations, Call Center Operations, Compliance, and external partners.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep members healthier. They've created custom software and analytics to empower clinical staff to intervene and provide personalized care. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
Perform outbound calls to obtain appropriate information and document accurately.
Answer in-bound calls and assist customers with pharmacy related services.
Contact insurance companies for benefit investigation and coverage eligibility.
IQVIA is a global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. They create connections that accelerate the development and commercialization of innovative medical treatments to improve healthcare and patient outcomes.
Enrolling practitioners in health plans in a timely and effective fashion.
Monitoring progress and ensuring timeliness of enrollment completion.
Maintaining provider enrollment goals for all divisions.
Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.
Respond to inquiries, providing expert guidance and support via in-app chat and phone.
Use AI-powered tools to efficiently research plan details and synthesize information for users.
Conduct comprehensive comparisons of Medicare Advantage plans, ensuring users understand their options.
Propel builds technology that strengthens the social safety net in America. Over 5.5 million Americans trust Propel today and they've grown revenue 35% YoY, reinventing entire benefit categories, including Medicare, around the real needs of low-income Americans.
Be accountable for Partner satisfaction and relationship
Build trusting relationships with Partners’ operational leadership
Maintain a comprehensive understanding of business and technical challenges faced by customers
SmithRx is a rapidly growing, venture-backed Health-Tech company. Their mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. They pride themselves for their mission-driven and collaborative culture that inspires their employees to do their best work.
Create innovative clinical programs, products, and services aimed at optimizing specialty and non-specialty drug management, support payer clients with their PBM and drug coverage decisions
Act as a detail-oriented advisor, using data-driven insights to evaluate pharmacy programs, identify trend drivers, outlier high-cost claims and drive improvements.
Monitor emerging market trends and drug pipelines to anticipate client impact and develop proactive solutions.
Pharmaceutical Strategies Group (PSG), an EPIC owned company, provides an integrated data and analytics platform that transforms member data into actionable intelligence, which drives improved management of drug spend and trend across both pharmacy and medical benefits. EPIC has over 60 offices and 3,000 employees nationwide.
Coordinate the end-to-end provider enrollment process for physicians, nurse practitioners, and physician assistants joining the medical group.
Prepare and submit enrollment applications to Medicare, Medicaid, and other applicable payers to establish billing privileges.
Maintain accurate provider data within internal systems (e.g., NPPES, PECOS, CAQH, and iCIMS/HRIS) to ensure consistency across platforms.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states and employing more than 1,000 clinicians plus other professionals.
Own and manage shared inboxes and ensure timely review, triage, escalation and routing of requests
Identify trends, risks, or recurring issues and ensure escalation and action planning
Conduct compliance audits, write corrective action plans and work with department managers to ensure timely completion and compliance with local, state and regulatory requirements
Centene is transforming the health of communities, one person at a time. As a diversified, national organization, they offer competitive benefits and a fresh perspective on workplace flexibility.