PBM Service Delivery Manager (Claims Adjudication & Governance)

Computer Task Group, Inc • Jersey City, NJ

8d • $95,000 - $100,000

About The Position

CTG is seeking a results-driven PBM Service Delivery Manager to lead claims adjudication and governance operations for a leading healthcare client. This role focuses on strategic oversight, operational excellence, and continuous improvement in PBM service delivery.

Requirements

• Demonstrated experience leading delivery or managed services within PBM, health plans, or healthcare technology organizations.
• Proven record in process improvement, claims operations, and service delivery excellence.
• Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.

Nice To Haves

• Hands-on experience with PBM platforms (e.g., RxClaim) and familiarity with ITSM/project tools (ServiceNow, Jira) is a plus.
• Strong understanding of NCPDP standards, pharmacy network systems, eligibility, accumulators, and clinical decision support integrations.
• Advanced degrees or certifications in pharmacy, healthcare management, or project management a plus.

Responsibilities

• Lead PBM service delivery and governance for claims adjudication, formulary rules, benefit hierarchies, and pricing logic.
• Analyze claims performance data to identify trends, reduce errors, and optimize workflows.
• Drive process improvement initiatives to enhance operational efficiency and compliance.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 501-1,000 employees