Benefits Manager

Job DescriptionJob DescriptionPOSITION SUMMARYThe Benefit Manager reports to the Implementations & Benefits Senior Director and is responsible of benefit configurations to both new and existing clients. They will provide management and supervision over team to monitor and track all functions related to new implementations and benefits administration and the improvement of quality and efficiency of all aspects related to clients’ specifications. Supports the hiring, training, and performance evaluation process. Additionally, responsible for the teams’ adherence to corporate attendance and employment policies.ESSENTIAL ROLES AND RESPONSIBILITIESProficient understanding of all job duties and responsibilities of all benefit team and other related departments like formulary, eligibility, IT, etc related to new implementations.Responsible for the validation benefit rules set, contracted networks, copayment rules set, DUR rules set and all necessary information into CUBE to ensure implementation with a set up margin error of <1%.Ensures that all rejected and paid claims are adjudicated and/or rejected as specified by the client and/or PharmPix policies and procedures.Ensure Benefits team compliance with client’s Performance Guarantees.Responsible for ensuring that the Benefit Implementation Form is signed by Full PBM clients and/or new Backend clients before the group’s effective date. Proactively monitor benefits team to identify and address service issues and escalate concerns appropriately and provide regular feedback of plan performance.Establishes responsible deadlines and personnel work plans; manages time effectively.Manages and develops teams’ skills, evaluates performance, provides feedback.Effectively manages and mentors the benefit team. Specific topics may include the creation and delivery of client presentations regarding benefit configuration activities.Provide oversight of projects and assist in the interpretation and context of client requests. Oversees and works with HR on resolution of employee relations issues and performance standards, productivity, and service standards.Works with HR leadership to conduct hiring, training, and evaluation of team members.Responsible for identifying and implementing opportunity and/or improvement areas that prevent recurrence of findings, including QIA findings, Validation findings and/or Client findings. Validates all deployments in production.Supports the Implementation and Benefits Senior Director in the oversight of new client implementations.Participates, contributes, and serves as backup of the Benefits Senior Director in Implementation Meetings.Direct interaction with Sales, Account Management and Development teams to follow-up on development requests affecting a client implementation and/or claims adjudication. Ensure prompt completion of assignments to include ticketing system and training. Maintain client documentation and administrative paperwork to expectation standards.Shows flexibility and a customized approach in meeting all types of client and internal customer communication styles and personalities. Demonstrates attention to detail, ability to work in an ever-changing workflow environment, patience, professionalism, and compassion while handling difficult client situations.Support all Quality Management Program initiatives.Complete department, corporate or special projects, as assigned.TRAINING & EDUCATIONBachelor’s Degree in Business or Healthcare related field; or equivalent work experience.Master’s degree a plus.LICENSURE / CERTIFICATIONN/APROFESSIONAL EXPERIENCEThree (3) years or more of experience in health insurance industry, PBM or professional job-related, required.Two (2) years or more of supervision experience, required. PROFESSIONAL COMPETENCIES Knowledge:Understanding of the managed care industries from the perspective of a PBM as well as providers of care. Knowledge of the purposes, organization and policies of the community’s health care delivery and pharmacy regulations/regulatory agencies.Knowledge of Microsoft applicationsFully bilingual English and Spanish.Proficiency in Microsoft Office.Skills:Must be detail oriented and highly organized.Manage multiple priorities and work independently or in a team in a fast-paced environment.Possess a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.Effective and Strong verbal, written and presentation communication skills.Demonstrate ability to develop strong working relationships. Customer focus and ability to meet client expectations. Abilities:Ability to manage people and provide team leadership.Ability to organize and integrate organizational priorities and deadlines.Ability to work independently or part of a team. Demonstrate ability to establish and maintain quality control standards.Ability to develop and maintain productive relationships with other internal departments, PharmPix clients and other health care professionals.

PHYSICAL AND MENTAL DEMANDSThe physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. While performing the duties of this job, the employee is regularly required to talk or hear, sit, stand, and walk.The position may require lifting and moving equipment up to 25 pounds.Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.ENVIRONMENTAL AND WORKING CONDITIONSThis job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and printers. The position may require evening or weekend work to support maintenance windows, system updates, and incident response.PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans