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.