Manager, Operations - Remote

Prime Therapeutics•Home, WV

1d•$81,000 - $138,000•Remote

About The Position

The Manager of Benefit Plan Configuration is responsible for leading and developing the Benefit Plan Administration team across multiple lines of business to ensure accurate and consistent programming of benefit plans. This role ensures operational goals, performance guarantees, and service level agreements (SLAs) are achieved by managing team performance, creating project plans, and overseeing execution against deadlines. The position applies deep knowledge of departmental workflows to assess cross-functional impacts and collaborates with internal and external stakeholders, including customers, members, and providers, to resolve escalated issues and deliver high-quality service.

Requirements

Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required
6 years of work experience in operations management, pharmacy benefit management, healthcare, insurance, retail, analytics, or operational compliance
2 years of leadership/people management experience
Must be eligible to work in the United States without the need for work visa or residency sponsorship

Nice To Haves

Advanced analytical and problem-solving skills with demonstrated ability to evaluate operational workflows and identify cross-functional impacts
Ability to lead teams through multiple, concurrent projects while ensuring compliance with strict timelines, SLAs, and performance guarantees
Proficiency in Microsoft Excel, Word, and business systems used for benefit configuration, with the ability to translate data into actionable insights
Demonstrated ability to develop and implement process improvements to drive efficiency and quality
Strong interpersonal, communication, and facilitation skills with the ability to influence across internal and external stakeholders
Ability to prepare and deliver documentation, reporting, and audit responses that ensure compliance with organizational and regulatory standards
3 years of people management experience in PBM environment
Experience analyzing benefit plans and programming rules to demonstrate a benefit structure with an automated claims processing system

Responsibilities

Manage employee performance through defined scorecards and performance metrics and provide ongoing feedback, coaching, direction, and development
Lead the team in organizational data validation projects to support major system enhancements or release updates
Oversee project management, programming, testing, and documentation activities to drive performance and ensure service level agreements (SLAs) are met or exceeded
Schedule employees, manage capacity, and coordinate activities to maintain appropriate workflow
Develop and document workflows, system requirements, system impact analyses, system design, process analyses, and testing, including reasonableness checks, using software development methodology to deliver efficient, cost-effective solutions as directed
Identify reporting needs based on system programming and workflows; document reporting requirements and conduct testing of new reporting prior to implementation in production
Create and maintain necessary functionality in ticketing systems, benefit landscapes, and workflows; recommend and implement solutions and evaluate results
Partner with client-facing teams to resolve client concerns and ensure identified improvement opportunities are effectively addressed and implemented
Other duties as assigned