Account Manager, PBM

3 weeks, 1 day ago
Full-time
Senior
Customer and Technical Support
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Partner with clinical account managers and account executives to support clients from implementation through go-live, renewal, and ongoing account management.
  • Manage timely and accurate execution of client benefit requests, including benefit changes, eligibility changes, override requests, demos, and new implementations.
  • Analyze incoming client requests and coordinate with internal and external teams to complete required plan documentation.
  • Support the implementation of new plans, pricing, and networks aligned to strategic or administrative intent.
  • Lead pre- and post-implementation quality assurance and testing to validate coding accuracy.
  • Lead claim reviews to identify discrepancies or inaccuracies and develop solutions to address them.
  • Handle and resolve sponsor and member issues, escalating when necessary.
  • Research and respond to claims processing and system configuration inquiries.
  • Coordinate integration of other data inputs into client management processes.
  • Collaborate cross-functionally to support general client operations and retention efforts.

Requirements

  • Bachelor’s degree with a record of strong academic performance.
  • 5+ years of proven experience in PBM, health plan, benefits consulting, or healthcare.
  • Experience building trusting internal and external relationships.
  • Experience leading cross-functional initiatives and executing deliverables on deadline.
  • Experience working with structured and unstructured data.
  • Proficiency in Microsoft Office; SQL is a bonus.
  • Ability to manage multiple complex projects simultaneously.
  • Exceptional written and verbal communication skills.
  • Highly flexible, organized, and able to shift priorities easily.
  • Strong attention to detail and commitment to delivering high-quality work product.
  • Must have authorization to work in the US at the time of application and throughout employment; no visa sponsorship is provided.
  • Travel up to 25%.

Benefits

  • Remote work for non-local candidates or hybrid work for candidates local to NYC, Denver, or Charlotte.
  • Base salary range of $80,000 to $100,000 USD.
  • Opportunity to work on enterprise health technology and pharmacy benefit management solutions.
  • Equal employment opportunity and a diverse, inclusive workplace.

Interested in this position?

Apply directly on the company website

Apply Now

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