Manager, Claims Operations

Job not on LinkedIn

October 14

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

+16 more states

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌪️ Kansas – Remote 🎰 Nevada – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

⚙️ Operations

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SmithRx

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Healthcare Insurance • SaaS • B2B

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $20M Series B on 2022-03

📋 Description

• Establish clear team goals and priorities in alignment with the broader Plan Operations and Customer Success strategy. • Manage the achievement of team and department objectives and key results (OKRs). • Perform regular team member coaching and identify team training opportunities, especially in new PBM technologies and compliance updates. • Actively participate in the full interview and onboarding life cycle for new hires, focusing on skills relevant to automated claims systems. • Identify process gaps and lead process improvement efforts for the claims operations team, emphasizing automation and digital transformation. • Ensure claims approvals and/or denials are made in accordance with company practices, procedures, and regulatory requirements (e.g., CMS, state mandates). • Be accountable for ensuring timely completion of non-electronic pharmacy claims for direct member reimbursement. • Oversee claim file review and analysis to support resolution of member disruption and complex claims issues. • Support new group implementation activities related to claims system configuration and management. • Oversee timely and accurate execution of mailed member communications associated with new group transitions to SmithRx.

🎯 Requirements

• 5+ years in a leadership role with direct reports, preferably leading people in a remote or hybrid setting. • 8+ years of working knowledge of claims processing, medical billing, healthcare benefits, and/or pharmacy benefits in a PBM or payer environment. • Experience with document management practices and member communication outreach is preferred. • Executive-level communication and interpersonal skills, with the ability to effectively navigate and mediate conflict and foster honest dialogue. • Passion for developing, inspiring, and leading teams composed of less-experienced employees. • Execution-focused ethos - you are a solutions-oriented problem solver and efficiency-driven. • Organized and thoughtful with the ability to handle competing issues and prioritize accordingly. • Comfortable with leading teams in a fast-changing environment.

🏖️ Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • 12 Paid Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities