Pharmacy Claims Lead
Job Summary
Providing strategic and operational leadership, the full-time Pharmacy Claims Lead will oversee pharmacy claims adjudication and configuration, ensuring compliance and performance across Commercial, Medicare, and Medicaid lines of business in a remote work environment.
Key Responsibilities
- Lead and develop a team focused on pharmacy claims configuration, validation, and monitoring
- Own and ensure the integrity of pharmacy claims adjudication logic and operational behavior
- Develop operational dashboards and metrics to track claims performance and compliance adherence
Required Qualifications
- Demonstrated leadership experience in operational or systems environments with direct people management
- Experience leading teams in configuration, validation, or operational control functions
- Strong analytical skills with proficiency in Excel and SQL for data interpretation
- Experience with operational metrics, reporting, and performance measurement
- Ability to manage stakeholders across technical and business domains
Complete Job Description
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