Pharmacy Claims Manager

About the role

The Pharmacy Claims Manager provides essential administrative and operational support to ensure effective coordination across internal teams. This role focuses on delivering organized, reliable and timely support for back‑office activities while maintaining strong internal partnerships and contributing to departmental efficiency.

Key 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 leaders.
• Perform Rx claim benefit validation/testing, maintain Salesforce GO updates, and coordinate external claim files.
• Provide reporting support, including data validation and trend identification.
• Support BCT outreaches and translate configuration communications.

Required profile

• Minimum 6 + years of experience in PBM or Rx claim environments.
• Strong analytical and reporting‑interpretation skills.
• Ability to prioritize multiple tasks in a fast‑paced production environment.
• Excellent communication and collaborative working style.
• Critical‑thinking and problem‑solving abilities for non‑standard situations.
• Self‑motivated with strong ownership and ability to work with minimal supervision.
• Project coordination or facilitation experience.

Required skills

• RxClaims tools
• Salesforce GO (SFGO)
• Microsoft SharePoint
• Microsoft Teams
• Microsoft Excel
• Microsoft Word
• Microsoft PowerPoint
• PBM tools and workflows
• Reporting tools
• Issue‑management tools
• Claims platforms