Sr. Manager, Claims Operations - Archimedes

Navitus Health Solutions, LLC•,

7d•Remote

About The Position

Archimedes is seeking a Sr. Manager, Claims Operations to lead and optimize end-to-end operational functions within its claims operations team. The role is responsible for accurate, timely, and compliant execution of pharmacy benefit services, overseeing complex workflows, external pharmacy and vendor performance, and cross-functional coordination to support client commitments, regulatory requirements, and financial integrity. The position combines strategic operations leadership with hands-on oversight. Its areas of responsibility include claims configuration and processing, claims quality, fee schedule management, direct pharmacy relationship management, copay assistance program oversight, and other duties assigned by leadership. The role is remote, with a listed work schedule of Monday through Friday, 8 a.m. to 5 p.m. CST.

Requirements

Bachelor’s degree in Business Administration or a related field, or equivalent work experience.
At least 5 years of claims operations experience.
At least 3 years of progressive leadership experience, which may include leading individual contributors or teams, or equivalent leadership experience such as coaching, mentoring, or leading complex initiatives or projects.
Experience in healthcare.

Nice To Haves

Experience with specialty claims, configuration, and complex programs such as copay assistance is strongly preferred.

Responsibilities

Lead and oversee the claims operations team to ensure efficient, accurate, and compliant business operations.
Manage day-to-day operational performance, ensuring service levels, quality standards, business objectives, and claims-related performance guarantees are met.
Lead, coach, and develop team members through performance management, goal setting, professional development, feedback, and career planning.
Ensure operational readiness for new initiatives, implementations, regulatory changes, and ongoing business needs.
Identify, assess, and mitigate operational risks, and implement corrective actions as needed.
Drive continuous process improvement to enhance efficiency, accuracy, scalability, and quality across claims operations.
Establish, maintain, and enforce operational policies, procedures, and controls.
Oversee daily claims quality assurance, including processes for configuration and fee schedules, and ensure monitoring and reporting mechanisms are in place.
Collaborate with internal stakeholders and external vendors, including partner pharmacies, to support operational objectives and resolve issues.
Monitor pharmacy and adjudicator performance against contractual requirements and service-level agreements.
Serve as an escalation point for complex or high-impact operational issues and drive timely resolution.
Ensure compliance with applicable laws, regulations, and internal governance standards.
Support audits, reviews, and remediation activities as required.
Provide regular operational reporting, insights, and recommendations to senior leadership.
Communicate operational status, risks, and outcomes to cross-functional partners.
Participate in, adhere to, and support compliance, people and culture, and learning programs.
Perform other duties as assigned.