Benefits Implementation Manager
Pharmpix Guaynabo, PR
- Expired: over a month ago. Applications are no longer accepted.
This is your chance to unleash your full potential!
PharmPix, is currently seeking for qualified Benefits Implementation Manager candidate to join our team. We are looking for successful people like you. Join the fastest growing Pharmacy Benefit Management (PBM) company in its category and take your professional career to the next level. PharmPix has become a leading provider of pharmacy benefit solutions and services in the continental United States and the territories.
Our work philosophy is based on commitment, dedication and loyalty. We take care of our employees, just as we ensure the welfare of our clients and partners. If you are creative, service oriented, resourceful and visionary, we would like to hear from you.
The Benefits Manager reports to the VP of Client Services and is responsible to oversee all matters related to PharmPix benefit administration and servicing. They will provide management and supervision over team to monitor and track all functions related to benefits administration and the improvement of quality and efficiency of all aspects related to clients’ specifications. They work with leadership team to recognize and recommend operational improvements as well as develop policies, procedures, and the strategic plan for the team. Supports the hiring, training, and performance evaluation process. Additionally, responsible for the teams’ adherence to corporate attendance and employment policies.
Essential Roles and Responsibilities
- Effectively leads, supervise, and tracks all functions related to benefits implementations to ensure quality and efficiency in all aspects related to client’s specifications.
- Provide and/or complete reports, as requested by internal or external clients.
- Accurately validate benefit rules set, contracted networks, copayment rules set, DUR rules set and all necessary information into CUBE to ensure implementation with a set up margin error of <1%.
- Ensures that all rejected and paid claims are adjudicated and/or rejected as specified by the client and/or PharmPix policies and procedures.
- Proficient understanding of all job duties and responsibilities of all Client Services Benefit team.
- Prepare and share key details with Client Services Manager and/or clients the Group and Benefit Association Report.
- Work with Client Services Supervisor to identify and document system deficiencies and recommend possible solutions.
- Participate as required on client’s implementation meetings.
- Validate all deployments in production.
- Ensure Benefits team compliance with client’s Performance Guarantees.
- Collaborate with IT, Internal Quality and Account Management to oversee the EOB process for contracted clients.
- Provides proactive and strategic support for achieving business goals and ensuring deliverables are on time and meet the quality levels expected by internal and external customers.
- Proactively monitor benefits administration team to identify and address service issues and escalate concerns appropriately and provide regular feedback of plan performance and outcomes to leadership.
- Manages and develops teams’ skills, evaluates performance, provides feedback, and works with Client Services Supervisor on team member evaluations.
- Contributes to team effort by accomplishing related results as needed.
Professional Experience and Skills Requirements:
- Bachelor’s degree in Business or Healthcare related field; or equivalent work experience.
- Puerto Rico Board of Pharmacy Technician Certification, preferred.
- Four (4) to six (6) years’ experience in the health insurance industry, PBM or professional job-related experience.
- Four (4) years client services or account management, preferred.
- Five (5) or more years of supervision experience.
- A thorough understanding of the managed care industries from the perspective of a PBM as well as providers of care.
- Knowledge of the purposes, organization and policies of the community’s health care delivery and pharmacy regulations/regulatory agencies.
- Knowledge of Microsoft applications
- Fully bilingual English and Spanish.
- Proficiency in Microsoft Office.
PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans
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