Plan and forecast staffing needs for RxCompass and Variable Copay teams, monitor real-time workload and service performance, and recommend operational adjustments. Develop and validate reports and dashboards, analyze performance trends, support capacity planning and staffing activities, and protect confidential information in accordance with HIPAA.
The agent is responsible for providing effective customer service by managing Rx claims inquiries and resolving billing complaints. They must maintain detailed records of interactions while ensuring compliance with HIPAA regulations regarding protected health information.
The Product Owner serves as the operational lead for the CRx specialty pharmacy solution, coordinating initiatives and ensuring alignment across cross-functional teams. They are responsible for managing project timelines, resolving operational issues, and translating business needs into actionable process improvements.
The Eligibility Analyst III manages complex eligibility workflows, ensuring data integrity and accuracy for claim adjudication. They serve as a senior escalation point, providing technical support and mentoring to junior analysts while collaborating with cross-functional teams.
The Senior Director provides strategic leadership and operational oversight for claims adjudication and eligibility operations, ensuring accuracy, compliance, and performance. They act as the primary technical authority, driving process improvements and managing cross-functional teams to meet client and regulatory standards.
The Manual QA Engineer validates pharmacy benefit technology, including claims adjudication logic and system functionality, to ensure accuracy and reliability. They design and execute test plans, document defects, and collaborate with cross-functional teams to verify fixes and support release sign-offs.
The Associate General Counsel assists the General Counsel with corporate legal initiatives, contract negotiations, and regulatory compliance within the healthcare and employee benefits industry. The role involves managing privacy policies, overseeing HIPAA adherence, and providing legal guidance to senior management.
The Associate Care Navigator manages specialty drug spend by acting as a single point of contact for members to provide personalized, cost-effective solutions. They collaborate with providers and internal teams to ensure compliance with HIPAA and ERISA while maintaining high service standards.
