Account Manager, PBM

Position Summary:

The Account Manager, PBM is responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations. Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent.

Position Responsibilities:

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  Partner with clinical account manager (CAM) and account executive (AE) to manage clients through the entire lifecycle from implementation through go-live and renewal on a designated book of business

  
  
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  Support implementation as a critical member of the client management teams with all day-to-day client requirements

  
  
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  Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, override requests, demos and new implementations

  
  
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  Analyze incoming client requests and work with internal and external teams to complete required plan documentation

  
  
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  Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent

  
  
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  Lead pre- and post-implementation quality assurance and testing to validate coding accuracy

  
  
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  Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address

  
  
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  Travel requirements not to exceed 25%

  
  
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  Handle and resolve sponsor and member issues, escalating as needed

  
  
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  Research and respond to claims processing and system configuration inquiries

  
  
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  Coordinate integration of other data inputs into client management processes

  
  
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  Collaborate cross functionally to support general client operations, as required

  
  
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  Responsible for relationship management and contribution to successful NPS and Account Management Survey results, along with retention support

  
  
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  Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

  
  

Qualifications:

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  Undergraduate bachelor's degree, with record of strong academic performance

  
  
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  5+ years of proven experience in PBM / health plan, benefits consulting, healthcare

  
  
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  Track record of building trusting internal and external relationships

  
  
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  Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables

  
  
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  Experience working with structured and unstructured data

  
  
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  Proficient in Microsoft Office, SQL a bonus

  
  
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  Ability to balance multiple complex projects simultaneously

  
  
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  Exceptional written and verbal communication skills

  
  
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  Extremely flexible, highly organized, and able to shift priorities easily

  
  
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  Attention to detail & commitment to delivering high quality work product

  
  

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.