About The Position
The Operations Specialist supports daily operational functions across claims processing, savings program administration, CRM management, and internal process coordination. This role plays a key part in maintaining billing accuracy, ensuring data integrity across systems, and supporting operational workflows that impact clients, members, and internal teams. The Operations Specialist serves as a subject matter expert for CRM processes, assists with operational issue resolution, and collaborates across departments to improve efficiency and ensure consistent operational performance. This role also supports reporting, claims-related research, and root cause analysis to help identify opportunities for process improvement and operational accuracy.
Requirements
- Background in operations, healthcare administration, pharmacy benefit management, or a related healthcare field.
- Experience working with CRM systems and operational workflow management.
- Familiarity with claims processing, billing reconciliation, or pharmacy benefit operations preferred.
- Strong analytical and problem-solving skills with the ability to identify trends and operational issues.
- Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
- Strong communication skills and the ability to collaborate effectively across teams.
Responsibilities
- Enter all alternative sourcing and patient assistance claims into the claims system to ensure accurate financial tracking and claims processing.
- Conduct savings program billing and ACM report reconciliation.
- Complete the weekly Savings Program report to ensure accurate tracking and reporting of plan savings.
- Maintain and submit billing basis information to the accounting team to support accurate invoicing and financial reconciliation.
- Perform backup copay checks and serve as backup support for weekly copay card verification processes.
- Facilitate operational communications between Script Care and internal teams to ensure alignment and timely issue resolution.
- Assist with monitoring the Script Care shared inbox and route inquiries to the appropriate internal teams for follow-up.
- Assist operational teams with claims-related questions, escalations, and issue resolution.
- Research and resolve operational issues impacting multiple members or clients, including discrepancies related to accumulators, deductibles, and claims processing.
- Assist in root cause analysis for operational issues or process breakdowns and help identify corrective actions.
- Collaborate with internal stakeholders to ensure timely resolution of operational issues and member-impacting concerns.
- Conduct general quality assurance (QA) and operational audit activities to ensure processes are functioning accurately and efficiently.
- Perform data cleansing activities to maintain accuracy and integrity across operational systems and reporting tools.
- Perform data analysis to support operational decision-making and identify areas for improvement.
- Conduct training sessions for internal teams on operational process updates and CRM system usage.
- Serve as the internal subject matter expert (SME) for CRM systems and support team members with CRM-related questions.
- Support CRM enhancements and system improvements by assisting with testing, troubleshooting, and user adoption.
- Create and maintain process documentation for internal workflows and operational procedures.
- Review client change requests to ensure a full understanding of the request and communicate operational requirements to internal teams.
- Assist the Director of Operational Coordination & Strategy with data research, claims adjudication support, and operational analysis as needed.
- Perform other related duties as assigned to support operational goals and team success.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
