Senior Manager, Pharmacy Appeals

Job Summary

Leading a team of colleagues and contractors, the full-time Senior Manager, Pharmacy Appeals will manage pharmacy reimbursement appeals, ensuring compliance with state regulations and timely processing while developing solutions to improve operations in a remote environment.

Key responsibilities

• Oversees pharmacy appeals service warranty process and ensures compliance with state regulations
• Leads and mentors the appeals team, providing strategic guidance to enhance performance and resolve complex inquiries
• Collaborates cross-functionally with legal and finance teams to align strategies and optimize appeals services

Required qualifications

• 7 years of experience in pricing, PBM/healthcare operations, or related fields
• 5+ years of direct leadership experience in operations teams
• 1+ years of experience with pharmacy appeal processes and state regulations
• Bachelor's Degree or equivalent experience required