Benefit Operations Supervisor

National Healthcare Solutions, Inc.

71d

About The Position

The PBM Benefit Operations Supervisor is responsible for overseeing the benefit design coding process while managing a team of benefit specialists. This position ensures accurate implementation of benefit structures within the pharmacy benefit management system and provides leadership in daily operations. The ideal candidate is detail-oriented and well-versed in benefit coding methodologies and operational workflows, with strong supervisory and team management skills.

Requirements

• Bachelor’s degree in a relevant field (Healthcare Administration, Information Technology, or related) preferred.
• Proven experience in benefit design coding, with a background in supervision or team leadership in a PBM or healthcare environment.
• Proficiency in benefit language and familiarity with PBM software.
• Strong problem-solving skills.
• Excellent communication and collaboration abilities across teams.
• In-depth understanding of pharmacy benefit management and healthcare industry regulations.
• Leadership qualities, with experience in leading and developing team members.

Responsibilities

• Lead and manage a team of benefit specialists, ensuring productivity, quality, and adherence to deadlines.
• Provide guidance, training, and mentorship to team members to foster growth and ensure effective performance.
• Conduct regular performance evaluations, provide constructive feedback, and implement development plans.
• Oversee the translation of benefit design specifications into system-readable formats for the PBM system.
• Ensure the team accurately codes benefit parameters using pharmacy platform systems.
• Collaborate closely with cross-functional teams, including actuaries, product managers, and IT, to ensure consistency and accuracy in benefit design coding.
• Supervise quality assurance processes to ensure coded benefit designs are functional, accurate, and compliant.
• Assist the team in identifying and troubleshooting coding discrepancies or anomalies.
• Work collaboratively with other departments to resolve issues and optimize benefit design performance.
• Oversee the maintenance of comprehensive documentation for benefit design coding processes and updates.
• Generate and review reports and analyses to track the performance and functionality of benefit designs.
• Ensure all documentation is accurate and meets regulatory requirements.
• Lead initiatives for process enhancements and operational efficiency in benefit coding and design.
• Stay current with industry trends, regulatory changes, and best practices in benefit design coding, and implement relevant improvements.
• Collaborate with management to refine benefit operations and align with organizational goals.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 11-50 employees