The Senior Claims Operations Lead will define and document claims workflows, standard operating procedures, and operational readiness plans for the World Trade Center Health Program. They will also provide technical subject matter expertise, mentor claims processors, and support quality improvement initiatives.
The Junior Healthcare Claims Analyst is responsible for reviewing and processing healthcare claims in accordance with established procedures, benefit requirements, and quality standards. They will also research claim discrepancies, document processing decisions, and escalate complex issues to senior team members.
The Pharmacy SME will provide expert guidance on pharmacy benefit design, acquisition strategies, and modernization efforts within the DoD and TRICARE environments. They act as a bridge between commercial innovation and military healthcare requirements to ensure compliant and mission-focused outcomes.
