Qualifications:

• PBM or RxClaim experience preferred (prior BOM or Rx Customer Service experience is a plus).
• Strong analytical, problem-solving, and critical-thinking skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in Microsoft Office tools (SharePoint, Teams, Excel, Word, PowerPoint).
• Strong communication, collaboration, and operational coordination skills.
• Experience with benefit design, configuration processes, and PBM tools preferred.
• Ability to quickly learn new systems, processes, and support cross-functional projects.

Responsibilities

• Lead and oversee Medical & Clinical Operations functions, ensuring team performance and operational excellence.
• Provide clinical guidance and support on disease management, care coordination, and medical management processes.
• Develop and improve policies, procedures, and clinical operation guidelines.
• Ensure compliance with company policies, procedures, and operational directives.