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Manager, Pharmacy Claims Operations



Plano, TX, USA · Remote
Posted on Tuesday, November 21, 2023

Who We Are:

SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

  • Integrity: Do the right thing. Especially when it’s hard.
  • Courage: Embrace the challenge.
  • Together: Build bridges and lift up your colleagues.

Job Summary:

The Manager, Claims Operations will lead the company’s day-to-day operational activities that support behind the scenes functions related to claims processing, mass member communications, implementation activities, and other technical responsibilities. This position will report to SmithRx’s Director, Plan Operations.

What you will do:

  • Establish clear team goals/priorities in alignment with the broader Plan Operations and
    Customer Success strategy
  • Manage the achievement of team and department objectives and key results
  • Perform regular team member coaching and identify team training opportunities
  • Actively participate in the full interview and onboarding life cycle for new hires
  • Identify process gaps and lead process improvement efforts for the claim operations
  • Ensure claims approvals and/or denials are made in accordance with company practices
    and procedures
  • Timely execution of mailed member communications
  • Oversees claim file review and analysis to support member disruption
  • Support new group implementation activities related to claims management
  • Be accountable for ensuring timely completion of non-electronic pharmacy claims for direct member reimbursement

What you will bring to SmithRx:

  • 5+ years in in a leadership role with direct reports required. Preferably leading people working in a remote setting
  • 8+ years of working knowledge of claims processing, medical billing, healthcare benefits, and/or pharmacy benefits
  • Bachelors or equivalent work experience required
  • Experience with document management practices is preferred
  • Executive-level communication and interpersonal skills, with the ability to effectively navigate and mediate conflict and foster honest dialogue
  • Ability to navigate unique and individual team member scenarios while providing coaching through the day-to-day challenges, and mentoring through a long-term relationship- based approach to drive linger term individual success
  • Ability to take initiative with little to no direction
  • Passion for operational excellence that directly impacts clients, partners and end users
  • Passion for building excellence and constantly iterating on process improvements
  • 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
  • Flexible, adaptable, and able to respond under the pressure of a fast-paced organization

What SmithRx Offers You:

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