ConnectiveRx

QA Engineer

• Coach Operations agents (peer to peer) on areas of opportunity for improvement found during evaluations, collaborate with training for Operations agents (i.e., new hire, refresher, and nesting training)
• Performs and documents results of all quality assurance evaluations on all operational products and services, including (but not limited to) benefit verification cases, patient assistance cases, software support calls/emails, inbound calls from patients or health care providers, data entry, etc.
• Participates in internal, vendor, or client calibration meetings as required to address quality initiatives but does not lead them
• Identifies and escalates critical quality issues appropriately to senior management
• Assists with other QA-related functions and responsibilities as needed to meet department and company goals
• Availability to work occasional evening and/or weekend hours to meet company and departmental goals as the business need arises
• Auditing work completed by Operations agents
• Sending feedback to Operations leadership on agent performance
• Attending meetings, helping with data analysis, and other duties as assigned

QA Associate

Program Manager

• Lead a team of Program Managers, providing strategic direction
• Assist in the design and implementation of client projects
• Identify and remove roadblocks to meeting client deliverables
• Collaborate with business stakeholders and cross-functional teams to execute on client objectives

Associate Director – Program Management

Pricing Analyst

• Leads projects to develop strategies, analytics, tools, and processes that enable the organization to grow operating margins by driving improvement to pricing and revenue management practices
• Leads Pricing Committee to ensure proper review, alignment, and approval of qualified opportunities
• Develops and implements a standard pricing system
• Establishes and implements a framework for measuring pricing execution, including pricing waterfalls, quarterly pricing metrics and market analysis
• Communicates recommendations and value created from implementation of strategies to EMT
• Maintains an understanding of industry and market trends, as well as regulatory updates

SVP, Pricing Strategy

Manager

• Responsible for managing a team of 45-60 staff members across one or more teams
• Oversees the delivery of patient support healthcare services that facilitate access to prescription medications
• Collaborates with internal stakeholders to implement updates
• Leads talent identification and onboarding efforts
• Tracks team credentialing
• Responsible for medium-sized and small programs (<$10m)
• Ensures accurate monthly client invoicing
• Communicates company and client-related messages to the team as indicated by the director
• Engages with client as required or requested by the program management team

Manager, Patient Support – Hub Services

Analyst

• Assists in the set-up and maintenance of affordability programs and other ConnectiveRx adjudicated program offerings
• Respond to and resolve business rule questions or concerns escalated by internal teams or adjudicator partners, escalating complex issues as appropriate
• Conduct quality control reviews on new program setups and requested updates to ensure accuracy, consistency, and adherence to established rules and standards
• Access, analyze, and interpret program and adjudication data to evaluate rule functionality; investigate discrepancies, anomalies, or incorrect outcomes and document findings
• Develop and maintain a working knowledge of adjudication claims engines and networks, including differences in system logic across multiple adjudicators
• Works proficiently within various tools (Salesforce, ManageEngine, CRx systems) to fulfill requests
• Support documentation updates and process improvements
• Primarily responsible for maintaining SOPs, work instructions, job aids, tracking logs and spreadsheets
• Participate in regularly scheduled adjudication calls, ad hoc meetings, and internal discussions; engage in training sessions as required to support operational objectives

Analyst – Adjudication

• Takes the lead to manage the Care Coordination process within an assigned territory.
• Uses tact and independent judgment to balance patient and physician needs with business realities.
• Establishes and maintains professional and effective relationships with all internal and external customers.
• Effectively manages database including data on each individual, their insurance, and interactions.
• Provides education to patients and health care providers, regarding insurance requirements and options.

Case Manager

AI Engineer

• Build and evolve AI automations and agent-based workflows
• Design scalable agent architecture and orchestration patterns
• Suggest and implement AI-driven automation enhancements
• Act as an internal AI advocate by providing training and mentorship
• Partner with senior engineers and cross-functional teams
• Participate in the full AI SDLC, including design sessions

Senior AI Engineer

Project Manager

• Develops project plans for schedule, resources, and budget
• Requires collaboration with resources managers, lead team members, Finance, and executives
• Coordinates with project teams to identify issues, risks, and opportunities for improvement
• Monitors and manages project quality to ensure project deliverables are acceptable
• Compiles and distributes project information, status reports, and portfolio budget expenditures
• Actively engage in continuous improvement of the organization's project management processes

Customer Support

• Answer inbound calls received by patients, healthcare providers, pharmacies, outside sales representatives, and clients by phone and respond to general program and product-related inquiries.
• Triage calls to designated internal team members or third-party entities for case-specific and targeted inquiries.
• Document case updates, escalations, or issues within the case management or ticket management system.
• Perform data entry tasks in multiple systems to support case intake, creation, updates, and patient enrollment.
• Respond to live chats to support hub-related general program and product-related inquiries and conduct follow-up activities.

Senior Patient Support Specialist – Hub Services

• Manage day-to-day client contact and respond to client requests
• Develop effective client-facing communications
• Complete Requests for Proposals and Statements of Work
• Coordinate program setup with internal teams and clients
• Monitor program performance and reporting

Program Management Manager

Recruitment

• Assists with job posting and advertisement processes.
• Sources qualified applicants by leveraging online recruiting resources (for example, LinkedIn) and in-house applicant tracking system.
• Screens applications, selects qualified candidates and schedules interviews.
• Assists with preparation of interview questions and other hiring and selection materials.
• Ensures compliance with federal, state, and local employment laws and regulations, and company policies.
• Assists in identifies and implementing efficient and effective recruiting methods and strategies based on the available role, industry standards, and the needs of the organization.
• Collaborates with the hiring manager and/or other human resource staff during the offer process, identifying and recommending salary ranges, incentives, start dates, and other pertinent details.
• Attends and participates in job fairs and recruiting sessions.
• Performs other duties, as assigned.

Talent Acquisition Specialist – II

• Develop and expand client relationships with new and existing clients, ensuring all major deliverables within their team are met
• Work with enterprise and program quality groups to ensure quality standards and client expectations are achieved, address client issues efficiently and effectively, and marshal cross-department resources when necessary
• Responsible for hiring, mentoring, setting goals, providing feedback and discipline, supporting professional development, and conducting annual performance reviews for a staff of Directors, Program Managers, and/or Lead Program Managers
• Collaborate within program management, product, and IT to ensure project and brand implementation occurs and launch dates are met
• Improve internal processes to ensure the team and organization operate effectively and efficiently toward common goals by facilitating client solutions for complex programs, including developing and improving operational process flows and SOPs
• Collaborate on strategic planning and the development of objectives and policies for the business unit
• Provide consistent oversight and subject-matter expertise to ensure operational compliance with all applicable standard operating procedures
• Manage portfolio profitability by working with finance and the VP of Operations to ensure accurate billing and staffing on a monthly basis
• Provide ongoing client contact and support to ensure complete client satisfaction by creating and delivering action plans to address service-related issues
• Perform other duties as assigned

Senior Director, Program Management

Business Analyst

• Collaborating with customers, product, external vendors, software engineers, quality analysts, and operations experts to deliver market-leading capabilities driven through the integrated solutions with the company’s platform services and microservices architecture
• Work closely with technology to define API requirements
• Document process flows to identify actors, inputs, outputs, and dependencies, as well as ensure software development decisions support process model
• Define epics and user stories and prioritize accordingly for project delivery design
• Create mockups, wireframes, and prototypes that illustrate current and future workflows to facilitate market research, user testing, and product
• Prioritize backlog to prep for agile ceremonies
• Drive user story grooming sessions and user story refinement
• Interpret and consult on technical specifications, such as data dictionaries, data flows, API specifications
• Support all phases of the software development lifecycle
• Provide and promote internal communication between software development, project management, product management, and other functional groups

• Supervises a team of Operations Quality Assurance Associates through monitoring day-to-day operations
• Manages and addresses employee requests, scheduling, payroll/timesheets, and productivity
• Ensures employee’s are well trained, delivering on department and individual objectives, and following company policies and procedures
• Reviews and assess Operations Quality Assurance Associates job performance and provides appropriate coaching and training to address positive and constructive feedback
• Delivers and supports activities of hiring, training/onboarding, goal setting, performance management, and employee development across multiple clients and programs
• Motivates and develops teams to drive consistent positive internal and external customer experience
• Conducts and facilitates regular group meetings with operations and program leaders to communicate agent performance and recommendations, partners with cross-functional departments to assists with implementation of new programs and processes
• Manages appeals process inquiries from operation leadership through research of program/client business rules/requirements
• Provides education and coaching to front-line BV/Operation agents, CMs, and QA associates, as necessary
• Acts as a SME for multiple clients/programs to meet customer SOPs/business rules and ensures monthly audit goals are met
• Presents/facilitates Quality Assurance data to communicate performance trends, process or training gaps, service improvements and efficiency opportunities
• Provides/develops recommended remediation actions or initiatives to drive improvements in Operations quality performance levels
• Oversees QA materials to ensure the success of business/customer deliverables to drive strong customer and patient experience