Key Responsibilities:

• Produce financial reports for clients and provide insights into trends

• Responsible for provider electronic withhold entries for audit recoveries for all benefits

• Monitor electronic withhold to satisfy timely audit recoveries

• Conduct quality review of audit reports for administrative accuracy and adherence to policies and timely submission to clients

• Review claim selections to ensure adherence to program guidelines.

• Collect and analyze quality assurance data for public sector client meetings and internal metrics

• Lead audit report review meetings with clients and prepare meeting minutes

• Ensure alignment and consistency of delivery of program between all benefits

• Identify emerging trends and create presentations for clients to support audit result meetings

• Work with both internal and external stakeholders to address client inquiries, gather, collect information, for deliverables

• Conduct monthly quality assurance review of staff time trackers

• Create and maintain forecasting tools for oversight on key performance indicators and emerging trends

• Oversee program training documents, SOPs, and working instructions. Ensure processes are mapped out, outlined and organized for team to utilize

• Maintain inventory of audit application scenarios to be used as a reference for team

• Lead quality-focused remedial training sessions for team. Assist managers with maintaining training records

• Identify, lead and manage special projects and program initiatives

• Continuously seek opportunities to create efficiencies within processes and drive value for the program

• Resolve non-routine issues escalated from other team members. Mentoring and developing team members using agile concepts.

• Tasks involve a degree of forward planning and anticipation of needs/issues

• Other duties as assigned

Qualifications:

• Bachelor’s degree or equivalent work experience

• Minimum of 4 years of related experience in Pharmacy and/or Dental Benefit Management, Group Insurance or Health Care Operations

• Highly proficient in Microsoft Access & Excel, and data warehousing applications

• Experience with compiling, manipulating or validating large pieces of data

• Ability to maintain electronic filing systems

• Display high levels of curiosity, integrity, tact and objective judgement

• Excellent organizational, planning and critical thinking skills 

• Excellent verbal and written communication skills, including ability to present to clients and internal stakeholders

• Proven interpersonal skills and ability to work well with senior management and high-level external contacts handling sensitive or confidential information is critical

• Ability to work with minimum management oversight on multiple projects with competing priorities

• Ability to work a flexible schedule in high pressure environments with urgent deadlines

• Proven time and resource management skills; detail oriented with strong organizational abilities.