PBM Operations Team Lead

Job Summary

Seeking a skilled PBM Operations Team Lead, the full-time remote position will manage operational performance, quality, and continuous improvement of pharmacy benefit processes while leading a team of analysts responsible for eligibility, accumulators, and claims adjudication accuracy.

Key Responsibilities:

• Lead a multi-disciplinary team ensuring timely issue resolution and operational efficiency across eligibility and claims functions
• Serve as a subject matter expert on PBM platforms and monitor daily performance metrics to implement process improvements
• Collaborate with cross-functional teams to resolve complex issues and ensure compliance with contractual and quality standards

Required Qualifications:

• Bachelor's degree in a related field or five years of relevant healthcare experience
• Minimum of two years of experience in healthcare eligibility, accumulators, and claims
• At least one year of leadership or supervisory experience
• Strong knowledge of eligibility management, benefit configuration, and claims adjudication
• Familiarity with HIPAA, PHI, and healthcare compliance requirements