About The Position
The Operations Specialist supports daily operations, billing accuracy, and CRM process management. This role serves as a subject matter expert for CRM, resolves operational issues, and ensures data accuracy across systems to optimize internal workflows and client satisfaction.
Requirements
- Background in operations, healthcare administration, or pharmacy benefit management.
- Experience with CRM systems and process workflows.
- Strong analytical, problem-solving, and organizational skills.
- Ability to communicate effectively and manage competing priorities.
Nice To Haves
- 3+ years of PBM/adjacent experience
Responsibilities
- Conduct savings program billing and ACM report reconciliation.
- Perform backup copay checks and ensure billing accuracy.
- Facilitate operational communications between vendors and internal teams.
- Assist operational teams with claims-related questions and issue resolution.
- Conduct training around process changes and CRM usage.
- Serve as CRM subject matter expert; support teams with CRM-related questions.
- Create and maintain process documentation for internal and external workflows.
- Support CRM enhancements and user adoption through training and troubleshooting.
- Assist in root cause analysis for process breakdowns.
- Research and resolve issues impacting multiple members or clients (e.g., accumulator discrepancies, incorrect deductible amounts).
- Collaborate with stakeholders to ensure timely issue resolution.
- Perform data analysis to support operational decisions.
- Conduct data cleansing to ensure accuracy and integrity across systems.
- Perform other related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
