The Senior Pharmacy Claims Manager provides essential administrative and operational support to ensure effective coordination across internal teams. The role focuses on delivering organized, reliable and timely support for key back‑office activities, maintaining strong internal partnerships and contributing to overall departmental efficiency. It anticipates operational needs, supports proactive planning and ensures commitments and deliveries are met. The position works closely with domestic Pharmacy Account Management partners to maintain accurate documentation, track progress and support ongoing process improvements.
Primary Responsibilities:
- Read, analyze and interpret SOPs, client documentation and reporting to support accurate task execution.
- Collaborate with multiple operational teams in a complex matrix environment to ensure high-quality, timely service delivery.
- Review existing processes and identify improvement opportunities to enhance accuracy and efficiency.
- Facilitate resolution of escalated requests by coordinating closely with internal partners.
- Identify solutions to non-standard issues and translate them into actionable steps.
- Manage assigned operational activities with daily interaction and alignment with PAM teams and PAM leaders.
- Perform other responsibilities as assigned by management.
- RxClaim benefit validation/testing.
- SFGO (Salesforce GO) updates and maintenance.
- External claim file coordination and outbound file support.
- Reporting support, including data validation and trend identification.
- BCT outreaches and translation of configuration communications.
Qualifications:
Mandatory Skills
- Minimum of 10 yrs above PBM and RxClaims experience preferred
- Must be knowledgeable in RxClaims tools
- Strong analytical and reporting‑interpretation skills.
- Ability to prioritize multiple tasks in a fast‑paced production environment.
- Excellent communication skills and a collaborative working style.
- Critical‑thinking and problem‑solving skills in non‑standard situations.
- Proficiency with Microsoft Office (SharePoint, Teams, Excel, Word, PowerPoint).
- Self‑motivated with strong ownership and ability to work with minimal supervision.
- Project coordination/facilitation experience.
Desired Skills
- Account management or operational client‑support experience.
- Strong ability to learn PBM tools and workflows.
- Experience with benefit design and configuration processes.
- Experience with PBM systems, reporting tools, issue‑management tools and claims platforms.
