Associate, Patient Assistane Eligibility & Program Integrity Manager

Lilly • Indianapolis, IN

11d

About The Position

At Lilly, we believe that every patient deserves access to the medicines they need. The Lilly Cares Foundation - a separate charitable organization - brings that belief to life through the Lilly Cares Patient Assistance Program (Lilly Cares PAP), which helps eligible patients access Lilly medications at no cost. Lilly PAP provides operational support to the Lilly Cares Foundation in running this program, and also supports Lilly's donation of medicines to other charitable organizations.
As the Eligibility Verification & Program Integrity Manager, you'l1 be at the heart of that mission. This role primarily supports Lilly PAP's operational support of Lilly Cares. We're looking for someone to lead the operational processes that verify patient eligibility, based on eligibility criteria established by Lilly Care, protect program integrity, and detect fraud, ensuring Lilly Cares PAP reaches the people it was designed to serve.
We're looking for a professional who thrives at the intersection of compliance, analytics, and patient advocacy. In this role, we'll rely on your expertise to safeguard the program and help us continuously improve the experience for patients and their care teams.

Requirements

• A deep understanding of the U.S. healthcare insurance landscape, including PBMs, pharmacy benefit optimizer entities, specialty pharmacies, and other third-party benefit programs
• Demonstrated experience in fraud prevention, detection, or compliance monitoring within healthcare or patient assistance operations
• The ability to interpret complex insurance documents - including SPDs, EOCs, drug formularies, and insurance verification records
• A history of leading and directing vendor and contractor teams, aligning them to program requirements and operational standards
• Strong analytical instincts - translating data and reports into trends, anomalies, and actionable decisions
• Clear, confident communication skills, both written and verbal, including experience communicating findings and recommendations to leadership
• Bachelor's degree in healthcare administration, public health, business administration, health sciences, or a related field
• 5+ years in U.S. healthcare benefit verification, patient assistance program operations, or specialty medication access
• Qualified applicants must be authorized to work in the United States on a full-time basis. Lilly will not provide support for or sponsor work authorization or visas for this role, including but not limited to F-1 CPT, F-1 OPT, F-1 STEM OPT, J-1, H-lB, TN, 0-1, E-3, H-lBl, orL-1

Nice To Haves

• Advanced degree or clinical credential (e.g., Pharm.D., RN, MBA)
• Familiarity with the U.S. payer environment - reimbursement structures, formulary management, and population-based healthcare decision-making as it relates to patient assistance
• Hands-on experience with electronic benefits verification tools (e.g., SureScripts, EBV platforms), insurance documentation review, and eligibility appeals
• Experience scoping monitoring tools, automation, and reporting requirements for PAP programs
• Strong organizational instincts with the ability to balance multiple concurrent workstreams across cross-functional teams
• Experience with Lilly internal approval processes (e.g., Veeva, Privacy) is a plus
• A compliance-first outlook and a genuine commitment to patient access

Responsibilities

• Own and continuously improve the operational support provided to Lilly Cares associated with eligibility verification processes, ensuring patient applications and supporting documentation are evaluated consistently and accurately against program criteria for Lilly Cares PAP (as established by Lilly Cares)
• Provide consultative leadership and quality oversight of vendor-performed eligibility reviews for Lilly Cares PAP, resolving complex escalated cases with sound judgment and ensuring accuracy, consistency, and compliance of determinations
• Identify, assess, and escalate emerging fraud risks and trends for Lilly Cares PAP -including those involving PBMs, specialty pharmacies, benefit optimizer organizations, and non-traditional benefit structures
• Strengthen the Fraud Protection and Prevention Framework as part of the operational support provided to Lilly Cares by monitoring trends, tracking suspected entities, and recommending updates to detection criteria and operational rules
• Drive execution quality of the operational support provided to Lilly Cares related to PAP monitoring plans in accordance with SOPs, ensuring vendor outputs meet standards for completeness, accuracy, and timeliness
• Review and approve monitoring documentation - including quarterly summaries, tools, and findings reports - and translate insights into actionable recommendations for leadership
• Leverage vendor data and analytics to surface patterns, flag discrepancies, and proactively address program integrity risks for Lilly Cares PAP
• Ensure compliance with privacy, legal, and regulatory requirements related to patient data - including data inventory, retention, and deletion practices - as part of the operational support provided to Lilly Cares
• Represent the operational support provided to Lilly Cares in routine eligibility and electronic benefits verification (EBV) governance forums, managing confidential information related to suspected or confirmed fraud with discretion
• Coordinate eligibility, monitoring, and fraud-related initiatives for Lilly Cares across PAP project managers and vendor teams - keeping timelines, deliverables, and dependencies on track
• Champion tools, automation, and process improvements that enhance verification accuracy, monitoring efficiency, and the overall experience for patients and their healthcare providers
• Keep Lilly Cares PAP application materials, SOPs related to the operational support provided to Lilly Cares, and program documentation current as requirements evolve
• Partner with Legal, Tax, Privacy, Data & Analytics, and PAP Operations to implement enhancements, compliance updates, and risk-mitigation strategies for Lilly Cares
• Set clear direction and governance for vendor and contractor teams supporting Lilly Cares in performing eligibility and monitoring activities, ensuring adherence to SOPs, business (operational) rules, and program standards
• Serve as the primary operational point of contact for vendor eligibility teams supporting Lilly Cares, communicating eligibility criteria updates (as established by Lilly Cares), process changes, and program expectations
• Collaborate with vendor program management supporting Lilly Cares on SOP revisions, operational readiness, and change implementation

Benefits

• Full-time equivalent employees also will be eligible for a company bonus (depending, in part, on company and individual performance). In addition, Lilly offers a comprehensive benefit program to eligible employees, including eligibility to participate in a company-sponsored 401(k); pension; vacation benefits; eligibility for medical, dental, vision and prescription drug benefits; flexible benefits (e.g., healthcare and/or dependent day care flexible spending accounts); life insurance and death benefits; certain time off and leave of absence benefits; and well-being benefits (e.g., employee assistance program, fitness benefits, and employee clubs and activities).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees