Insurance Operations Manager Jobs in Toronto, ON

Job Description Summary

PSP Operations Manager, Reimbursement
Location: Toronto, #LI-Hybrid
Novartis is unable to offer relocation support for this role; please only apply if this location is accessible for you.
About the role:
We are seeking experienced and passionate professionals to join us in accomplishing our ambitious mission of reaching twice as many patients twice as fast. As PSP Operations Manager, Reimbursement, you will have ownership of our Retrobilling and Copay strategies and play a critical role in identifying and addressing reimbursement process bottlenecks. This role aims to maximize commercialization, improve Time-to-Commercialization and Retrobilling rate, as well as minimize copayment overexposure and misbilling. To succeed, you'll need extensive knowledge of Canadian drug reimbursement, pharmacy Retrobilling, copay card management, payer collaboration, and the ability to extract insights from PSP data.
The role reports directly into the PSP Operations Lead and will work closely with PSP Operations, Value and Access, Commercial, Data, product cross-functional teams, and external vendors.
Permanent position.

Job Description

Key Responsibilities:

• Driving Reimbursement Insights: Analyze data from CRM systems to gain insights into payer behaviors, trends, preferences, and coverage decisions to help identify bottlenecks and areas for improvement in reimbursement.
• Collaboration with Market Access: Collaborate closely with Market Access teams to develop strategies for improving payer bottlenecks and listing criteria.
• Implementing data-driven solutions: Alleviate payer bottlenecks by proposing and implementing data-driven solutions, such as reimbursement tools, guidelines, and CRM enhancements
• Monitoring and evaluating payer trends: Continuously monitor and evaluate payer trends, policies, and regulations using CRM data and external resources to help identify shifts in reimbursement policies, market dynamics, and payer preferences.
• Copay Strategy Ownership: Strategically develop copayment card programs with appropriate structure, reporting, and management that maximizes patient value while minimizing overexposure and misbillings from pharmacies.
• Pharmacy Retrobilling Strategy: Maximizing pharmacy retrobilling nationally by developing and implementing a comprehensive control and oversight process which establishes and monitors targets, proactively identifies missed opportunities, analyzes the root causes of retrobilling errors, and develops strategies to optimize recovery.
• Performance Management: Develop comprehensive reporting, proactively identify discrepancies, and implement optimization strategies for PSP and pharmacy performance in commercialization, retrobilling recovery, and copayment expenditures, leveraging influence without formal authority.
• Reimbursement Training: Conduct training sessions to enhance cross-functional teams' understanding of reimbursement processes and collaboration with field teams.

Essential Requirements:

• Hands-on experience with Patient Support Programs (PSPs), collaborating directly with payers to drive reimbursement initiatives, and expertise in national pharmacy retrobilling processes, including the ability to analyze and optimize retrobilling opportunities using data and insights.
• Proven experience in managing copay card programs, developing and implementing effective strategies that maximize patient value while minimizing overexposure or misbillings from pharmacies
• Strong interpersonal skills and the ability to work cross-functionally, collaborating with internal teams and external stakeholders to incorporate technology and drive program success.

Desirable Requirements:

• HCP Experience: Experience working within a healthcare system as a healthcare professional (HCP) or in a related capacity.
• Bilingual English/French: Proficiency in both English and French languages is desirable.

Rewards

At Novartis, we're committed to reimagining medicine together - and rewarding the people who make it happen.

Expected Remuneration Range for role:

• CAD 125,120 - 173,700

The base salary offered is determined based on gender-neutral objectives, such as relevant skills, competencies and experience in accordance with the Novartis pay setting policy and upon joining Novartis will be reviewed periodically.

In addition to your base salary, you may be eligible for a performance-based bonus depending on certain performance parameters. Further details will be provided during the application process.

The rewards of being part of our team go far beyond base pay and incentives.We also offer a variety of competitive benefits in kind to help you thrive personally and professionally, such as insurance plans, retirement plans, wellbeing resources and global recognition programs. In addition, we provide flexible and hybrid working options, where possible, and minimum 14 weeks paid parental leave.

Pay equity is a fundamental principle of our employment policy and reflects our commitment to create a diverse, equitable and inclusive environment that treats all employees with dignity and respect, as outlined in our Code of Ethics.

Read our brochure to learn more about our global total rewards offering: https://www.novartis.com/sites/novartis_com/files/novartis-life-handbook.pdf

Note: Benefits and compensation may vary by country and are subject to local legal requirements. A full overview of your compensation package applicable to your role based on your employment location and Novartis employer entity, will be communicated separately to you during the application process.

At Novartis Canada, we are determined to be a valued partner and advocate, with a deep understanding of patient needs along the entire care journey - from drug development, to diagnosis, to access and beyond. Part of the way we are doing this is by leveraging data, technology, and partnerships.

Research & Development: we focus on four core therapeutic areas: Cardiovascular, Renal & Metabolic, Immunology, Neuroscience and Oncology. We also develop and deliver treatments through other promoted and established brands, which today are helping millions of patients. Over the last three years, our average annual research and development investment in Canada was over $30 million, and we conduct clinical trial research in every region throughout Canada.

Commitment to Diversity and Inclusion: Novartis is committed to building outstanding, inclusive work environment and diverse team's representatives of the patients and communities we serve.

Skills Desired

Agility, Analytical Thinking, Brand Awareness, Business Analytics, Cross-Functional Collaboration, Digital Marketing, Marketing Strategy, Media Campaigns, Project Management, Project Planning, Sales, Stakeholder Engagement, Stakeholder Management, Strategic Marketing, Waterfall Model