Claims Operations Team Lead

Job Summary

A company is looking for a PBM Eligibility, Accumulator, & Claims Team Lead (Operations).

Key Responsibilities

• Lead a team to resolve issues and ensure optimal performance in data, claims, eligibility, and accumulations
• Act as a subject matter expert and collaborate with IT on solutions related to Eligibility and Claims Adjudication
• Manage TPA relationships and oversee client implementations and performance metrics

Required Qualifications

• Bachelor's degree in Computer Science, Information Technology, Business, or related discipline
• 7+ years in a related field, with 5+ years in Eligibility, Accumulators, Claims Adjudication, and/or Data Analysis
• 2+ years of SQL proficiency is required
• Experience with GDPR, HIPAA, PHI, PII compliance; proficiency with SQL, GIT, and DevOps
• Agile methodology experience