Operations Specialist (MUST HAVE 3+ YEARS OF PBM/ADJACENT EXPERIENCE)

Position Summary
The Operations Specialist supports daily operations, billing accuracy, and CRM process
management. This role serves as a subject matter expert for CRM, resolves operational
issues, and ensures data accuracy across systems to optimize internal workflows and
client satisfaction.

Job Responsibilities

• Conduct savings program billing and ACM report reconciliation.


• Perform backup copay checks and ensure billing accuracy.


• Facilitate operational communications between vendors and internal teams.


• Assist operational teams with claims-related questions and issue resolution.


• Conduct training around process changes and CRM usage.


• Serve as CRM subject matter expert; support teams with CRM-related questions.


• Create and maintain process documentation for internal and external workflows.


• Support CRM enhancements and user adoption through training and
  troubleshooting.


• Assist in root cause analysis for process breakdowns.


• Research and resolve issues impacting multiple members or clients (e.g.,accumulator discrepancies, incorrect deductible amounts).


• Collaborate with stakeholders to ensure timely issue resolution.


• Perform data analysis to support operational decisions.


• Conduct data cleansing to ensure accuracy and integrity across systems.


• Perform other related duties as assigned.

Required Experience

• Background in operations, healthcare administration, or pharmacy benefit
  management.


• Experience with CRM systems and process workflows.


• Strong analytical, problem-solving, and organizational skills.


• Ability to communicate effectively and manage competing priorities