Specialist, Managed Care Operation

Sanofi•Morristown, NJ

2d•Hybrid

About The Position

The Managed Care Specialist is responsible for contract management for various markets including Commercial Contracts, Medicare Part D and Managed Medicaid. This position will support National Pharmaceutical Benefit Manager (PBM) customers. Responsibilities include timely and accurate loading of contracts and amendments, eligibility, and adjudicating payments in accordance with contracted terms and conditions across Sanofi’s pharmaceutical portfolio in multiple systems including ECP (Electronic Claims Processor) and Revenue Manager (Model N administration system). This position will analyze and pay rebates based on contract language, formulary placement and utilization management policies. The candidate will have a fundamental understanding of contract strategies, markets and Sanofi products and will prepare invoice payment results providing insights and feedback on trends and issues. The Specialist will work in close cooperation with Managed Care Operations colleagues and counterparts in Contract Development, the Account team, Legal, Pricing & Analytics and Digital. Join the team transforming care for people with immune challenges, rare diseases, cancers, and neurological conditions. In Specialty Care, you’ll help deliver breakthrough treatments that bring hope to patients with some of the highest unmet needs.

Requirements

Bachelor’s Degree (Accounting, Economics, Finance or Business are preferred)
Strong oral and written communication skills
Professional manner and tact
Organized, accurate and detail oriented, disciplined and dedicated to superior quality work
Strong sense of commitment and teamwork
Ability to work independently
Ability to multi-task and meet established deadlines

Nice To Haves

1-3 years of work experience preferred
Strong Excel skills
Model N experience
Deep analytical skills and ability to dissect the intricate reasons of rebate trends and variances
Ability to clearly communicate analysis to the business parties
Independent problem solving and leadership skills in managing the account
Proficient in Microsoft Office Tools

Responsibilities

Manage all aspects of contracts of the assigned PBM/payor including fully understanding the terms and conditions to appropriately set up contracts, update for contract amendments and adjudicate claims accurately.
Illustrate deep understanding of the contract and be able to effectively interpret and analyze key components of the contract.
Analyze rebate payments utilizing reporting tools and third party data sources illustrate rebates and market share trends.
Robust understanding and analysis of variances vs. prior periods.
Provide meaningful, concise trending and variance commentary to Senior Management as needed.
Cross functional communication with Contract Development and Account teams, ensuring understanding and awareness of customer issues.
Ensure accuracy of system validations including 340B
Verify that all product and eligible members comply with contract requirements
Analyze product formulary placement and utilization management policy to ensure appropriate contract tier placement and rebate payment.
Extensive interaction with both external customers and key internal stakeholders to resolve any data discrepancies
Analyze contract exceptions for interpretation in the system(s) for accuracy of calculations/process compliance
Ensure all payments are fully compliant with the terms of the contract
Provide accurate 3 month rolling Cash Flow forecast for customers
Participate in ad hoc projects