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

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, pioneering value-based pharmacy care. They are seeking an Operations Team Lead to manage a team of analysts, ensuring optimal performance and quality 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 • Bachelor’s degree in Computer Science, Information Technology, Business, or related discipline. • 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). 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/. Apply tot his job Apply To this Job