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Pharmacy Claims Manager

Company: Conduent Incorporated
Location: Elkridge
Posted on: June 13, 2021

Job Description:

About Conduent Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Job Description CANDIDATES MUST BE LOCAL OR WILLING TO RELOCATE TO THE ELKRIDGE, MARYLAND AREA WITHIN THREE MONTHS OF AN ACCEPTED OFFER. INDIVIDUAL SELECTED FOR THIS ROLE WILL BE EXPECTED TO WORK ONSITE POST-COVID19. The Pharmacy Claims Manager shall function as the liaison for all system requirements between MPP and Contractor. This role must be 100% dedicated to the contract and will be located at the Contractor's local facility. Responsibilities: Responsible for the technical management of the pharmacy claims processing program, standard/ad hoc reporting requests along with the testing of pharmacy claim processing enhancements. Assists the Pharmacy Account Manager with the operations of the pharmacy program. Manages and provides leadership for the delivery of highly complex projects, programs and/or portfolios prioritized in alignment with the client's expectations and business needs. Projects may include multiple disciplines and/or significant business process re-engineering efforts. Manages people for programs or portfolios involving department or cross-functional teams focused on the delivery of projects and/or programs into a finished state. Plans and directs programs and/or portfolio resources and budgets. Organizes enterprise portfolio management activities to include strategic planning, forecasting, project prioritization, resource allocation and budgeting. Directs the activities of project support staff, project managers, program managers, and sub-contractors and is responsible for ensuring appropriate resources are allocated and maintained to facilitate the successful completion of the project. Assigns and monitors work of subject matter expert personnel, providing support and interpretation of instructions/objectives. Manages and coordinates priorities between programs within a given portfolio that requires critical thinking and complex problem solving. Develops and maintains reporting procedures and monitor performance in portfolio control activities; develops and distributes reports related to portfolio activities, general portfolio management, and financial issues. Qualifications: Minimum of two (2) years of experience in a Management position. Minimum of three (3) years of experience serving as a liaison between technical and operational claims processing teams. Minimum of three years' experience in testing, implementation, and maintenance of a large-scale pharmacy benefits management claims processing system (this is a claims processor role, not pharmacy- based processing. Medicaid is a plus). Previous experience in creating use cases, requirement analysis documents, detail specification documents, resolving production problems and developing user acceptance test plans and knowledge of development life cycles. Bachelor's degree in Computer Science, Engineering or another relevant field. SQL reporting experience preferred (Adhoc Business Objects knowledge is a plus). Closing Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy.

Keywords: Conduent Incorporated, Baltimore , Pharmacy Claims Manager, Other , Elkridge, Maryland

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