Note: The job is a remote job and is open to candidates in USA. Paysign, Inc. is seeking a Benefit Operations Manager to serve as a key liaison with pharmacy and medical benefit processing partners while managing patient affordability programs for pharmaceutical companies. The role leads benefit configuration and program operations, monitors claims and resolves issues, supports implementations, supervises or mentors operations staff, and ensures compliance with HIPAA and program rules.
Responsibilities
- Build, modify, and validate benefit setup and adjudication configuration for assigned programs, including copay structures, maximums, eligibility rules, and edits
- Execute change orders accurately and on time, following documented change-control and peer-review procedures
- Review and approve test claims and validation checks before configurations go live
- Maintain complete, audit-ready documentation of configurations and changes
- Monitor program claim activity, exceptions, and rejects; investigate anomalies and resolve or escalate as appropriate
- Research adjudication questions from Account Management, Patient Support, and clients, including reject codes, reversal behavior, and coordination-of-benefits scenarios
- Support root-cause analysis on operational incidents and implement corrective actions
- Track and report operational metrics for assigned programs
- Partner with Implementation on new program builds and launch validation
- Support Account Management with timely, accurate answers on program behavior
- Supervise or mentor operations staff as assigned, including work review and training
- Ensure all work complies with HIPAA and documented program rules
Skills
- • Bachelor's degree or equivalent professional experience
- • 5+ years in benefit or claims operations, PBM, pharmacy, or healthcare operations
- • Working knowledge of claim adjudication and benefit configuration
- • Strong analytical and problem-solving skills with high attention to detail
- • Disciplined process orientation and documentation habits
- • Operational execution
- • Attention to detail
- • Analytical thinking
- • Problem solving
- • Communication
- • Organization
- • Quality focus
- • Prolonged periods of sitting or standing at a workstation and sustained computer use
- • Frequent verbal and written communication, including extended telephone and video conferencing
- • Occasional lifting and transporting of up to 15 pounds (files, equipment, or event materials)
- • Travel as required, typically less than 10%, which may include air travel and overnight stays
- • Remote work requires a suitable, private home work environment with reliable and secure internet connectivity
- • Copay or patient assistance program experience
- • Knowledge of PBM or pharmacy systems and NCPDP reject codes
- • Prior supervisory experience
- Certified Pharmacy Technician (CPhT) credential is a plus, given the frequency of client and patient questions involving pharmacy workflows, claim adjudication, and point-of-sale processing
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