Senior Manager, Pricing – Pharmacy Appeals

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Oversee a team of colleagues and contractors in the administration of pharmacy reimbursement appeals.

• Ensure that appeals are processed within strict Turnaround Times (TATs) and with exceptional accuracy.

• Create and implement strategies to enhance and automate processes.

• Mentor the appeal team coordinators and provide support to other internal business units.

• Collaborate with the legal and compliance team to ensure that state regulatory updates are effectively operationalized.

• Guide and support team members through counseling and mentorship.

⛳️ Requirements

• 7 years of experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related fields.

• Over 5 years of direct experience in leading operations teams.

• At least 1 year of experience with pharmacy appeal-related processes, state regulations, and claims adjudication, including claims adjudication logic.

• Proficiency in Excel, MS Access, Salesforce, and Pharmacy Portal.

• Capability to perform under tight deadlines.

• Strong mathematical problem-solving abilities.

• Prior knowledge of PBM.

• Familiarity with wholesaler invoices.

• Bachelor’s Degree or equivalent experience is required.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.