Note: The job is a remote job and is open to candidates in USA. EmpiRx Health is the leading clinically-driven pharmacy benefits management company, focused on value-based pharmacy care. They are seeking an Operations Team Lead to manage a team of analysts, ensuring optimal performance in data, claims, eligibility, and accumulations while driving operational excellence and implementing client-specific solutions.

Responsibilities

Lead POD team to resolve issues and close tickets effectively; ensure peak performance in data, claims, eligibility, and accumulations.
Serve as subject matter expert on Eligibility, Accumulator Platforms, Plan Benefit Designs, and Claims Adjudication; collaborate with Data Engineering and IT on solutions.
Build and maintain TPA relationships; ensure smooth onboarding for new clients and implementation of plan amendments.
Drive configuration requirements for new client implementations; oversee user acceptance testing (UAT) and apply feedback for solution improvements.
Monitor and drive performance metrics across operational areas; proactively identify and implement process enhancements.
Manage feature backlogs, run scrum sessions, groom stories, and deliver solutions in an Agile environment.
Ensure adherence to HIPAA, GDPR, PHI, PII, and internal data security standards.
Partner with Client Management, Production Support, and other teams to maintain effective communication channels.

Skills

7+ in a related field; 5+ years in Eligibility, Accumulators, Claims Adjudication, and/or Data Analysis; 2+ years SQL proficiency (required).
Experience with GDPR, HIPAA, PHI, PII compliance; Proficiency with SQL, GIT, DevOps; Analytical problem-solving skills.
Strong time management and communication skills.
Agile methodology experience.
2+ years Azure Databricks or ADF (preferred).

Education Requirements

Bachelor’s degree in Computer Science, Information Technology, Business, or related discipline.

Company Overview

EmpiRx Health is a Pharmacy Care Management organization that provides innovative pharmacy benefit and patient care management solutions. It was founded in 2014, and is headquartered in Montvale, New Jersey, USA, with a workforce of 201-500 employees. Its website is http://www.empirxhealth.com/.

[Remote] PBM Eligibility, Accumulator, & Claims Team Lead (Operations)

Job Type