Operations

• 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.

Manager, Claims Operations

Senior Global Operations Manager

Operations Engineer

ABA Regional Operations Manager

Operations Manager

VP, Growth Strategy and Operations