VP of Operations
Sparrow Early Learning
Manager, Claims Operations
SmithRx
full-time
Posted on:
Location Type: Remote
Location: Remote • Arizona, California, Colorado, Florida, Kansas, Minnesota, Montana, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin • 🇺🇸 United States
Visit company websiteJob Level
SeniorLead
About the role
- Establish clear team goals and priorities in alignment with the broader Plan Operations and Customer Success strategy.
- Manage the achievement of team and department objectives and key results (OKRs).
- Perform regular team member coaching and identify team training opportunities, especially in new PBM technologies and compliance updates.
- Actively participate in the full interview and onboarding life cycle for new hires, focusing on skills relevant to automated claims systems.
- Identify process gaps and lead process improvement efforts for the claims operations team, emphasizing automation and digital transformation.
- Ensure claims approvals and/or denials are made in accordance with company practices, procedures, and regulatory requirements (e.g., CMS, state mandates).
- Be accountable for ensuring timely completion of non-electronic pharmacy claims for direct member reimbursement.
- Oversee claim file review and analysis to support resolution of member disruption and complex claims issues.
- Support new group implementation activities related to claims system configuration and management.
- Oversee timely and accurate execution of mailed member communications associated with new group transitions to SmithRx.
Requirements
- 5+ years in a leadership role with direct reports, preferably leading people in a remote or hybrid setting.
- 8+ years of working knowledge of claims processing, medical billing, healthcare benefits, and/or pharmacy benefits in a PBM or payer environment.
- Experience with document management practices and member communication outreach is preferred.
- Executive-level communication and interpersonal skills, with the ability to effectively navigate and mediate conflict and foster honest dialogue.
- 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.
Benefits
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- 12 Paid Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingmedical billinghealthcare benefitspharmacy benefitsautomated claims systemsprocess improvementdigital transformationdocument managementclaims system configurationmember communication
Soft skills
leadershipcoachingexecutive communicationinterpersonal skillsconflict mediationteam developmentproblem solvingefficiency-drivenorganizational skillsadaptability
