Job Description
About Our Client: The organization operates in the enterprise health technology sector, offering integrated solutions for employers and health plans. It addresses challenges in healthcare benefits management through three main services: a full-service pharmacy benefit management platform for self-insured employers, comprehensive health benefit management for employers, TPAs, and health plans, and a proprietary Enterprise Health Platform that consolidates claim administration workflows into one scalable, secure system. This approach aims to improve trust and infrastructure in the U.S. healthcare system . About the Opportunit y: The Government Program Operations Specialist is responsible for managing the daily operations of the Government Programs Operations team. This hands-on role supports Medicare Part D, Medicaid, and Exchange business functions, providing career growth opportunities while ensuring operational accuracy and compliance. The position plays a key role in maintaining system integrity, driving process improvements, and facilitating cross-functional collaboration to support organizational goa ls. Responsibilit ies: Manage the Government Programs Operations team shared mailbox, ensuring timely and accurate resp onses• Lead pharmacy outreach initiatives related to CMS disputes, ensuring regulatory compl iance• Validate system enhancements by analyzing output data and identifying discrepa ncies• Design and update documentation frameworks including job aids, policies, and training mate rials• Develop and optimize workflows and job aids to standardize processes and improve effic iency• Oversee daily PDE reconciliation, analyze trends, and address discrepa ncies• Manage and resolve escalations from claims monitoring using root cause analysis and collabor ation• Support strategic initiatives with process improvements and subject matter expe rtise• Plan and facilitate cross-functional meetings to align teams and resolve i ssues• Collaborate with team members and business partners to improve operations and meet objec tives Require ments: Minimum 3 years of relevant exp erience• High school diploma r equired• Experience with Medicare Part D and/or Pharmacy Technician pr eferred• Strong organizational skills with attention to detail and a ccuracy• Experience in high-growth, startup environments is an ad vantage• Positive attitude and excellent interpersonal communication skills• Commitment to high-quality customer service internally and ext ernally• Flexibility to handle diverse work sit uations• Ability to work under pressure and manage multiple pri orities• Ability to work independently and collaborate effectively acros s teams Pay Range and Compensation Package: Remote, US Salary Range $69,200 to $10 0,000 USD• New York, NY Salary Range $87,200 to $10 9,000 USD• Denver, CO Salary Range $80,000 to $10 0,000 USD Equal Opportunity Statement Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or natio nal o rigin. Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.