This position will provide leadership in the development of the next generation PBM claims processing system strategy and software solution needs. Provides analysis of options, benefits, costs and risks. Develops the business architecture to integrate people, processes and technology. Creates tangible business strategies, facilitates planning activities, facilitate analytics, executes activities and measure results. Drives business architecture, change management and solution implementation. Responsibilities also include, but are not limited to research, pricing, conceptualizing, mobilizing teams and cross functional partnerships with IT and Operations while launching new systems, features and enhancements.
-Identifies and executes initiatives to enhance quality/performance/compliance requirements and/or transform the company`s PBM claims processing system capabilities.
-Translates customer and operational needs into recommendations and specifications enhancements and leverages creativity to design new solutions for Operations and Customer Experience.
-Provides operational leadership and is responsible for leading multi-disciplinary teams for execution.
-Serves as the company`s subject matter expert for PBM claims processing system business needs and impact.
-Prioritizes deliverables and translates into product roadmaps.
-Negotiates at all levels, finding common ground and obtaining buy-in around strategies and tactics.
-Delivers professional presentations to senior leadership, external customers, and consultant audiences.
-Facilitates external vendor relationships and partnering to design and build strategic initiatives.
-Performs other duties as assigned.
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
A solid understanding of SDLC, specifically Scrum or other Agile software development methodologies., Minimum 8 years combined experience in PBM operations, preferably within the managed care industry, plus 4+ years of experience in a leadership role.
Thorough knowledge of the healthcare industry, specifically PBM and Specialty Pharmacy.
Comprehensive understanding PBM functioning and client needs/wants to creatively recommend customer experience design, technology and business process integration, leading industry thoughts while meeting financial goals of the company.
Knowledge of Customer Service, Workforce Planning, and overall strategies to balance quality and efficiency
Bachelors degree required in Business Administration, Healthcare or related field.
Experience in the coordination and collaboration of work teams and a proven track record of success while working in any of the following functional areas: Product Management and Development, or PBM Operations.
Proven track record of results and deadline adherence.
Experience in the design, management, and implementation of business process, system re- platform, new products including the coordination and integration of all primary business functions.
Strong organizational, consultation and analytical skills.
Strong verbal and written communication skills are essential.
Self-starter and ability to work independently or as part of a team.