Point C

Pricing Analyst

• Review and reprice medical claims using contracted provider network rates
• Apply appropriate discounts based on PPO, rental networks, and client agreements
• Validate billed charges against fee schedules and contract terms
• Identify pricing discrepancies and escalate issues when necessary
• Communicate with internal teams regarding claim status and pricing questions
• Maintain accurate documentation and notes within claims systems
• Meet productivity and accuracy standards
• Follow HIPAA and data privacy guidelines at all times

Claims Repricing Coordinator

Administration

• Manage contracts from intake through drafting, review, negotiation support, execution, and post-execution tracking.
• Draft and revise agreements using approved templates and evaluate proposed deviations from standard language.
• Review and support negotiation of contractual terms, including indemnification, limitation of liability, termination provisions, amendments, and HIPAA privacy and security requirements.
• Ensure alignment between executed agreements, proposals, RFP responses, pricing structures, and operational capabilities.
• Manage renewals, amendments, and regulatory-driven updates.
• Identify non-standard or high-risk provisions and escalate material risks as appropriate.
• Maintain accurate contract documentation and version control.
• Collaborate cross-functionally to support compliant and efficient contract execution.
• Assist with audits, regulatory inquiries, and contract-related reporting.
• Support ongoing improvements to templates, workflows, and contract tracking processes.

Contract Administrator

Customer Support

• Collaborate closely with the sales team to support and execute stop loss marketing strategies.
• Analyze and scrub client data to prepare comprehensive and accurate marketing requests.
• Act as a liaison between stop loss carriers and the sales team, ensuring smooth communication and efficient exchange of information.
• Submit and track network reporting requests with accuracy and timeliness.
• Manage workflows and deadlines across multiple concurrent projects—organization and attention to detail are essential.
• Foster teamwork and collaboration by being a reliable, communicative, and solutions-oriented partner within a cross-functional environment.

Stop Loss Sales Support Specialist

Content Writer

• Evaluates and provides feedback on plan and benefit design. Participates and engages in discussion with internal and external partners related to benefit interpretation
• Research plan provisions contained in benefit plan documents including clarifying ambiguities contained in the plan language and provisions
• Provides timely documentation to users to help them reference, understand plan changes
• Maintains design specifications through documentation and revisions.
• Creating renewal business plan amendments.
• Consult with internal compliance expert and review client plan contracts, SPD’s, SMM’s to ensure compliance with Federal and State law.
• Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy client’s needs while minimizing the impact on system and operations

Document Writer

Marketing

• Develop and execute multi-channel marketing campaigns that generate awareness, drive engagement, and convert leads into opportunities
• Contribute to the strategy and content development of marketing campaigns, including thought leadership, case studies, and product positioning
• Support the Point C People team with internal comms and employee branding
• Analyze and optimize performance across all marketing channels, using data to inform decisions and improve ROI
• Collaborate with sales and operational teams to ensure strong alignment between marketing efforts and revenue goals
• Stay current on marketing trends and tools, bringing new ideas to enhance strategy and execution

Senior Marketing Manager

Operations

• Oversees and manages pharmacy phone queue, ensuring exceptional member experience, appropriate documentation, and effective customer service.
• Tracks key performance indicators and provides reports to manager in a timely manner.
• Maintains reasonable member satisfaction goals and works with the team to meet them.
• Interacts with members should calls need to be escalated to management.
• Onboards new employees and trains them based on their expertise and skill set.
• Proactively identifies potential member disruption.
• Answer inbound calls and return voicemails from members, delivering exemplary customer service and support.
• Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM.
• Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues.
• Document all actions, progress, and communication in the ticketing system and Acuity, updating ticket status in accordance with internal standards.
• Conduct proactive member outreach, including but not limited to disruption list communications and follow-up calls.
• Collaborate closely with Pharmacy Services team members and cross-functional departments to ensure timely resolution of pharmacy-related concerns.
• Perform other duties as assigned.

Pharmacy Benefit Operations Supervisor

Business Analyst

• Gather, analyze, and document requirements for business projects and process improvements.
• Collaborate with stakeholders to understand business objectives, workflows, and needs.
• Translate business requirements into functional specifications for development and implementation.
• Recommend solutions or enhancements to address business needs.
• Partner with project managers, developers, QA, and other teams throughout the SDLC.
• Create process flows, data models, use cases, and user stories to support solution design.
• Conduct gap analysis and impact assessments.
• Support UAT by developing test cases, validating results, and assisting with user training.
• Monitor project outcomes and identify opportunities for future optimization.
• Facilitate meetings, workshops, and presentations with managers and end users.
• Ensure compliance with all company policies, procedures, and applicable regulations.
• Perform other duties and special projects as assigned.

Manager

• Create and promote adherence to treatment plans, as developed by patients’ healthcare providers
• Create and maintain accurate, detailed clinical patient reports for clients and carriers
• Monitor and document adherence to treatment plans, evaluate effectiveness, monitor patient progress in a timely manner
• Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
• Increase patients’ ability for self-management and shared decision making
• Increase comprehension through culturally and linguistically appropriate education
• Assist with medication reconciliation
• Connect patients to relevant community resources, with the goal of enhancing patient health and wellbeing.
• Serve as the contact point, advocate, and informational resource for patients, care team, family/caregiver(s), stop-loss carrier, and community resources
• Assess a patient’s unmet health and social needs
• Acknowledges patient’s right on confidentiality issues, always maintains patient confidentiality and follows HIPAA guidelines and regulations

Case Manager

Business Intelligence Developer

• Design, build, and maintain Power BI reports and dashboards supporting healthcare, financial, and operational analytics.
• Develop and optimize semantic models, relationships, measures, and calculated columns.
• Create and maintain complex DAX measures aligned to healthcare KPIs such as utilization, claims, eligibility, quality, and financial performance.
• Partner with business and clinical stakeholders to translate requirements into clear, actionable analytics.
• Ensure BI solutions follow best practices for performance, scalability, usability, and security.
• Administer the Power BI Service, including workspace configuration, security, dataset refreshes, user access, and row-level security.
• Monitor report and dataset performance and resolve refresh, gateway, and licensing issues.
• Establish and maintain Power BI standards, documentation, and governance practices.
• Support deployments across development, test, and production environments.
• Perform other duties as assigned in support of analytics and business initiatives.

Senior PowerBI Developer

Claims Specialist

• Adjudicate new claims and process adjustments, including denials upon receipt of additional information
• Review and resolve appeals and subrogation/third-party liability cases
• Manage individual inventory to ensure timely turnaround and production goals are met
• Ensure claims are processed in accordance with stop loss contract terms
• Respond to internal and external inquiries via email and other channels within established timeframes
• Follow up on missing or incomplete information to ensure claims can be accurately processed
• Maintain minimum production, financial, and procedural accuracy standards on a monthly basis