Sr. Manager, Claims Operations - Archimedes

Navitus Health Solutions / Lumicera Health Services; United States; Remote; USD 110.000 - 150.000; Vollzeit

Benefits dieser Stelle

Health insurance

Dental & Vision

PTO 20 days

Parental leave

Holidays 9 days

401K match

Adoption assistance

FSA

Education & membership assistance

Referral bonus

Zusammenfassung

Archimedes in the United States is seeking a Sr. Manager, Claims Operations to lead and optimize end-to-end claim operations, ensuring accurate, timely, and compliant processing of pharmacy benefit services.

This role involves strategic oversight of configuration, processing, quality, fee schedules, and vendor management. You will lead and develop the team, drive continuous process improvements, and collaborate with internal stakeholders to meet client commitments, regulatory requirements, and

Qualifikationen

• Bachelor’s degree in Business Administration or related field, or equivalent work experience.
• 5+ years of claims operations experience.
• 3+ years of progressive leadership experience.
• Experience with specialty claims and copay assistance preferred.
• Experience in healthcare required.

Aufgaben

• Provide leadership over the claims operations team to ensure efficient, accurate, and compliant execution of business operations.
• Manage day-to-day operational performance, ensuring service levels, quality standards, and business objectives are met.
• Lead, coach, and develop the team members, including performance management and career development.
• Ensure operational readiness for new initiatives, implementations, regulatory changes, and ongoing business needs.
• Identify, assess, and mitigate operational risks, implementing corrective actions as necessary.
• Drive continuous process improvement initiatives to enhance efficiency, accuracy, and scalability.
• Establish, maintain, and enforce operational policies, procedures, and controls.
• Oversee daily claims QA and related QA processes for configuration and fee schedules.
• Collaborate with internal stakeholders and external vendors to support objectives.
• Monitor performance against contracts and SLAs, serving as escalation point when needed.
• Ensure compliance with laws and internal governance; support audits and remediation.

Kenntnisse

Leadership

Claims operations

Process improvement

Stakeholder collaboration

Healthcare knowledge

Ausbildung

Bachelor’s degree in Business Administration or related field

Tools

CRM systems

Analytics tools

Jobbeschreibung

Company

Archimedes

About Us

Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $0.00 - USD $0.00 /Yr.

STAR Bonus % (At Risk Maximum)

13.50 - Manager, Clinical Mgr, Pharm Supvr, CAE, Sr CAE I

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am-5pm CST

Overview

Archimedes is seeking a Sr. Manager, Claims Operationsto join our team!

The Sr. Manager, Claims Operations is responsible for leading and optimizing end-to-end operational functions, ensuring accurate, timely, and compliant execution of pharmacy benefit services within the claim operations team. This role oversees complex operational workflows, external pharmacy and vendor performance, and cross functional coordination to support client commitments, regulatory requirements, and financial integrity.

The Sr. Manager, Claims Operations acts as both a strategic operator and a hands-on leader, driving process improvement, issue resolution, and operational readiness across direct team and cross-functional teams. Areas of responsibility include claims configuration and processing, claims quality, fee schedule management, direct pharmacy relationship management, copay assistance program oversight, and other critical duties as assigned by leadership.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Provide leadership and oversight over the claim operations team to ensure efficient, accurate, and compliant execution of business operations.
• Manage day-to-day operational performance, ensuring service levels, quality standards, and business objectives are met, including any claim operations related performance guarantees
• Lead, coach, and develop the team members, including performance management, goal setting, and professional development.
• Ensure operational readiness for new initiatives, implementations, regulatory changes, and ongoing business needs.
• Identify, assess, and mitigate operational risks, and implement corrective actions as necessary.
• Drive continuous process improvement initiatives to enhance efficiency, accuracy, scalability, and quality across all claim operations core functions
• Establish, maintain, and enforce operational policies, procedures, and controls.
• Oversee daily claims QA and related QA processes for configuration, fee schedules and all other quality assurance activities, ensuring appropriate monitoring and reporting mechanisms are in place.
• Collaborate with internal stakeholders and external vendors, including partner pharmacies, to support operational objectives and resolve issues.
• Monitor pharmacy and adjudicator performance against contractual requirements and service level agreements.
• Serve as an escalation point for complex or high impact operational issues and drive timely resolution.
• Ensure compliance with applicable laws, regulations, and internal governance standards.
• Support audits, reviews, and remediation activities as required.
• Provide regular operational reporting, insights, and recommendations to senior leadership.
• Communicate operational status, risks, and outcomes clearly to cross functional partners.
• Establish, mentor, and develop team members through coaching, feedback, and career planning, ensuring a pipeline of future leaders and a culture of accountability and growth.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Qualifications

Whatourteamexpectsfrom you?

• Bachelor’s degree in Business Administration or related field, or equivalent work experience, required.
• 5+ years of claims operations experience required.
• 3+ years of progressive leadership experience, which may include leading individual contributors or teams, or equivalent leadership experience such as coaching, mentoring, or leading complex initiatives or projects, required.
• Experience with specialty claims, configuration and complex programs such as copay assistance strongly preferred.
• Experience in healthcare required.

What can you expect from Archimedes?

• Top of the industry benefits forHealth,Dental,and Vision insurance
• 20 dayspaidtimeoff
• 4 weeks paid parental leave
• 9paid holidays
• 401Kcompany match of up to 5%- No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membershipassistance
• Referral Bonus Program – up to $750!

#LI-Remote

Location : Address

Remote

Location : Country

US