POSITION SUMMARY
The Manager, Data Operations will be responsible for the implementation, integration, management, and delivery of data interchange with PBMs. The role will oversee the implementation and ongoing maintenance of PBM related processes including daily Rx claim files, medical accumulator files/questions related to, Rx data warehouse files, etc. The position will direct the day-to-day operations of PBM integrations including management, maintenance, reporting while developing and ensuring robust quality standards.
ESSENTIAL FUNCTIONS
- Manages day to day operations and inquiries related to RxClaims data
- Reviews, prioritizes, and assists with reported discrepancies in claims data, accumulators, and member complaints
- Establishes SLAs for issue resolution and transparency on process
- Establishes and maintains relationships with the PBMs that Allied has connections with
- Oversees the daily processing of all inbound and outbound data processing
- Manages Data Analysts
- Demonstrates a strong understanding of the internal business needs and technical requirements
- Develops and implements new data management audits and quality assurance protocols
- Project manages PBM projects to completion
- Establishes data connections with trading partners
- Interfaces with Allied’s IT team on projects and data management strategies
- Ensures all PBM file changes are executed correctly and timely
- Builds strong, collaborative, cross functional teams and trusted business relationships
- Acts as Allied’s internal and external point of contact for data management issues
- Acts as a liaison between Allied’s internal team and external trading partners
- Acts as an escalated point of contact for data management issues
- Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
- Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
- Actively engage, coach, counsel and provide timely, and constructive performance feedback.
- Work on special projects, duties or tasks as assigned.
EDUCATION
- Bachelor’s degree or equivalent work experience required
- Project Management Professional (PMP) certification desired
EXPERIENCE AND SKILLS
- Minimum of 5 years of experience in similar role preferably data operations in healthcare and/or insurance.
- At least 3 years at a supervisor level and successfully demonstrated leadership competencies
- Previous project management experience.
- Required experience with the following applications: SQL, and Microsoft Power BI
- Working knowledge of data management, data warehousing, and coding languages
- Excellent knowledge of data integration program involving all components including source systems, ETL, data quality/integrity, database, and delivery mechanisms and EDI business processes, practices, and procedures within healthcare environment
- Strong work-ethic and positive attitude and exceptional ability to manage multiple projects across functional teams in a fast-paced environment
- Strong communication skills (both verbal and written) and an ability to provide recommendations on data integrations and applications
- Strategic, conceptual analytical thinking and decision-making skills.
- Ability to advise on complex technical matters to all stakeholders; ability to communicate effectively with senior management.
POSITION COMPETENCIES
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Accountability
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Coaching and Feedback
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Collaboration
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Customer Focus
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Decision Making
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Execution Management
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People Leadership
PHYSICAL DEMANDS
- This is an office environment requiring extended sitting and computer work.
WORK ENVIRONMENT
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
