[Remote] Lead, Benefits Testing at SmithRx

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health-Tech, Pharmacy Benefit ManagementIndustries

Requirements

2+ years in a leadership role with direct reports, preferably leading people in a remote or hybrid setting
5+ years of working knowledge of claims processing, medical billing, healthcare benefits, and/or pharmacy benefits in a PBM or payer environment
Strong analytical skills with the ability to interpret complex data sets and benefit plan designs
Strong communication and interpersonal skills (via face-to-face meetings, conference calls, and written correspondence)
Excellent attention to detail and organizational skills
Knowledge of industry regulations and standards
Experience with Six Sigma or other quality improvement methodologies is preferred
Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges

Responsibilities

Manage team members in the delivery of benefit operations quality assurance, including testing and documentation, to meet or exceed service level agreements
Manage employee performance through defined employee scorecards and performance metrics
Provide ongoing feedback and coaching to ensure performance targets are met and provide appropriate levels of direction and support to your team members
Develop and deploy daily audits to assess the quality and accuracy of the Benefit Configuration Specialists/Analysts work products
Analyze audit results to identify trends, discrepancies, and areas for improvement
Develop and implement quality improvement plans and corrective actions
Provide leadership support to team members for escalations and complex configuration requests
Communicate project status to leadership, escalating issues when appropriate, and drive changes to improve workflow efficiency
Participate in initiatives to support process and workflow improvements and leverage new system capabilities
Collaborate with engineers and benefit operations teams on system enhancements to create workflow automation and resolve issues
Participate in the development and enhancement of quality assurance policies and procedures

Skills

Key technologies and capabilities for this role

Team ManagementCoachingBenefits TestingQuality AssuranceAuditsDocumentationPlan Operations

Questions & Answers

Common questions about this position

What is the salary or compensation for the Lead, Benefits Testing role?

This information is not specified in the job description.

Is this a remote position or what is the location requirement?

This information is not specified in the job description.

What skills or experience are required for this role?

The role requires strong leadership and team management skills, expertise in quality assurance and auditing for benefits operations, performance management through metrics and scorecards, data analysis to identify trends, and the ability to develop improvement plans.

What is the company culture like at SmithRx?

SmithRx has a mission-driven and collaborative culture that inspires employees to do their best work, guided by core values of Integrity, Courage, and Together.

What makes a strong candidate for the Lead, Benefits Testing position?

A strong candidate will have proven experience managing and coaching teams in quality assurance, particularly in benefits operations, with skills in auditing, performance management, data analysis, and driving process improvements.

SmithRx

Pharmacy benefit management with transparent pricing

About SmithRx

SmithRx operates as a Pharmacy Benefit Manager (PBM) that focuses on managing prescription drug plans for self-insured employers and plan sponsors. The company uses a transparent pricing model called "Pass Through Pricing," where it charges only an administrative fee and passes all rebates from prescriptions directly to clients and their members. This model contrasts with traditional PBMs that often inflate drug prices and retain rebates for profit. SmithRx's clients benefit from a technology platform that utilizes real-time data to improve service delivery, ensuring efficient and high-quality pharmacy benefit management. The company also provides a concierge service to enhance support for both members and clients. SmithRx aims to simplify pharmacy benefits while maximizing value for its clients through transparency, advanced technology, and exceptional customer service.

San Francisco, CaliforniaHeadquarters

2016Year Founded

$94.8MTotal Funding

SERIES_CCompany Stage

HealthcareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Unlimited Paid Time Off

Paid Holidays

Wellness Program

Commuter Benefits

Parental Leave

Mental Health Support

Professional Development Budget

Risks

Increased competition from technology-driven PBMs like Capital Rx could erode market share.

Rapid technological advancements may require costly updates to SmithRx's platform.

Potential regulatory scrutiny on PBM pricing models could impact SmithRx's business model.

Differentiation

SmithRx uses a transparent 'Pass Through Pricing' model, unlike traditional PBMs.

The company leverages real-time data for efficient pharmacy benefit management services.

SmithRx offers concierge-level service, enhancing customer satisfaction and support.

Upsides

SmithRx secured $60M in Series C funding, indicating strong investor confidence.

Partnership with Banjo Health enhances prior authorization processes using AI technology.

Collaboration with TheracosBio offers cost-effective drug options for Type 2 Diabetes.

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