Pharmacy Systems Operations Lead - Claims & PA
EmblemHealth
EmblemHealth is seeking a pharmacy systems coding subject matter expert in New York, NY to ensure efficient processing of medical drug claims. The role involves collaborating with various healthcare teams to enhance systems and processes, requiring a Bachelor's degree and extensive experience in claims processing and pharmacy coding. The ideal candidate will manage multiple tasks in a fast-paced environment, demonstrating excellent communication skills and attention to detail. A competitive hiring range is offered to align with the candidate's experience. #J-18808-Ljbffr EmblemHealth
- JobRx, Inc. is seeking a Pharmacy Systems Coding Subject Matter Expert in New York to assist with Prior Authorization and medical drug claim processing. You will be instrumental in claims automation and troubleshooting system issues. The ideal candidate has a Bachelor's...Claims
$112.67k - $193.15k
Siemens Mobility seeks a Service Operations Manager in Harleysville, PA, responsible for managing service agreements and leading teams in the Security Systems business. The ideal candidate will oversee hiring, monitor performance, and drive revenue growth while ensuring...Suggested$20 - $21 per hour
...About the Role We are seeking a detail-oriented and motivated Pharmacy Technician Authorization Specialist to join our remote... ...through prior authorizations. Navigate pharmacy dispensing systems to adjudicate claims, process refills, and support patient adherence. Work...ClaimsFull timeRemote workFlexible hours- ...more customers, reimbursing claims instantly, and financing every... ...looking for an AI Enablement Lead to make this the reality at Taktile... ...-leverage, internal-facing operations role: you won't be building... ...customer data or production systems. What You'll Need 5+ years...ClaimsWork at officeWorldwideHome office3 days per week
- ...direction of the Director of Pharmacy and Pharmacy leadership, the Clinical... ...and insurers. Resolve claim rejections and provide product... ...activities and outcomes. Advanced / Lead Responsibilities (as assigned)... ...The Mount Sinai Health System is an equal opportunity employer...ClaimsFull timeTraineeship
$140k - $165k
...Senior Manager, Core Business Systems leads the delivery, support, and... ...core business and insurance operations. The role primarily uses Guidewire... ...administration, billing, and claims platform, while also... ...location in CA, CT, MA, NJ, NY, and PA. Benefits Competitive base...ClaimsTemporary workWork at officeRemote workHome officeFlexible hours- ...practices plus insurers, pharmacies, family members, and... ...data in incompatible systems leaves seniors and families... ...the Founding Head of Operations, you are the operating... ...day. Time tracking, claims submission, acceptance... .... Track outcomes and leading indicators, run the...Claims
- Gainwell Technologies LLC seeks a Certified Pharmacy Technician to support pharmacy operations by assisting members and providers with inquiries related to benefits and claims. This role offers remote work flexibility while ensuring exceptional service in a high-volume...ClaimsRemote job
- Paramount Pictures in New York is looking for a Senior Manager, Business Operations. This pivotal role manages the Airtable operating system that supports end-to-end business operations, from budget and vendor management to task prioritization. The ideal candidate has at...
- Spotify is looking for a leader to manage the Financial Systems Operations team in New York. This role involves overseeing and improving the operational health of financial systems while managing a team of analysts to ensure smooth operations. The ideal candidate has over...
- A leading global fashion brand is looking for a Manager, Omni Operations / Inventory Systems & NSO Processes in New York. This role involves managing inventory systems and overseeing store operations for new openings and renovations. The ideal candidate will excel in project...
- Liberty Companies LLC is seeking an Operations Support Manager to support the regional operational team in managing systems and providing administrative support. The role involves overseeing payroll processes and coordinating office activities. Responsibilities include...Work at office
- Voiceflow is seeking an Operations Lead in New York City to enhance internal operations and campaign activations. You will collaborate closely with the founders to refine systems and drive efficiency across various projects. This role emphasizes both strategic system development...
- Lovable is looking for a part-time creator operations expert to help scale their program in the United States! This role requires someone who excels at organization, is passionate about creating systems, and understands influencer partnerships. Responsibilities include...Part time
$60.3k - $132.6k
...local, individual providers, small groups/systems) while servicing larger provider... ...resolution of escalated issues related to claims payment, contract interpretation and parameters... ...analysis of rate proposals, identifying operational and financial improvement opportunities,...ClaimsHourly payFull timeContract workWork experience placementWork at officeLocal area$70k - $85k
WizeHire, Inc is seeking a remote Assistant Operations Manager to join its growing mortgage operations team. You will... ...background in mortgage operations and a passion for leading teams and building effective systems. Competitive salary ranges from $70,000 to $85,000 annually...Remote job- Pharmacy Intern - TN or PA Job Category: Pharmacy Management & Operations Requisition Number: PHARM006992 Part-Time... ...Dragonfly Health is the leading care-at-home data,... ...current on processes, systems, and professional development... ...by assisting with claims adjudication and...ClaimsPart timeInternshipLocal areaRemote work
- ...intelligent data management, pharmacy optimization, and value... ...equitable by improving operations at community care... ...operational and compliance lead for Coral’s 340B... ...discrepancies before and after claim submission. Conduct... ...sessions with health system and infusion provider stakeholders...ClaimsRemote jobContract work
$23 per hour
Position: Pharmacy Prior Authorization Specialist Location: Pittsburgh, PA Job Id: 5273 # of Openings: 1 Pharmacy Prior Authorization Specialist - Onco360 Pharmacy... ..., addressing and rectifying rejected claims and conducting necessary third‑party authorization...ClaimsFull timeTemporary workRemote workRelocation package$180k
British American Household Staffing is looking for a Director of Household Operations in New York. This full-time role involves building efficient systems for household logistics and managing staff and vendors. Ideal candidates have a strong background in P&L ownership,...Full time- ...day. The Deputy Director of Pharmacy Operations is responsible for oversight... .... The Deputy Director will lead the team responsible for coordination... ...of enterprise-wide pharmacy systems and processes, including... ...interpretation of pharmacy claims data and other clinical data...ClaimsContract work
- Capital One is seeking a Design Operations Manager in New York to align design, product, and operations teams, scaling processes and systems for faster delivery. You will influence cross‑functional stakeholders, ensure clear communication, and solve complex challenges...
$50k - $60k
Join to apply for the Clinical Operations Lead (US, Remote) role at Vira Health Vira Health is... ...environments and wants to build the systems that make great care possible. You’ll work... ...to coverage, benefits, or denied claims Coordinate clinician schedules, navigate...ClaimsRemote jobFull timeImmediate start- ...Great American Insurance Group. As one of the leading commercial transportation insurers in the... ...in product design, loss control and claim services has made National Interstate one... ...such as Associate in Claims (AIC).Prefer PA NJ MA state handling experienceScope of Job...ClaimsRemote jobFull timePart timeSeasonal workLive outWork at officeLocal area
$1,500 per week
...Multi-Line Field Adjuster (Remote in NY, NJ or PA) Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location... ..., mobile documentation tools, and estimating/reporting systems Experience handling field claims in property, liability, or...ClaimsPermanent employmentFull timeTemporary workLocal areaRemote workShift work- Job Summary The Pharmacy QA Specialist plays a critical role... ...PBM, managed care, pharmacy operations, or healthcare setting... ...deadlines Proficiency in computer systems and documentation... ...process over 200,000 insurance claims annually for leading national and regional...ClaimsRemote jobTemporary workWork at officeWork from home
$66.33k - $145.86k
...negotiations of contracts with large, complex, and national group/system providers to maintain and enhance provider networks while meeting... ...experience. Residency requirement: candidates must reside in PA, DE, NY, NJ, MD, or Washington, DC. Preferred Qualifications Health...Full timeContract workTemporary workWork experience placementWork at officeLocal area- People Operations Lead Company Overview At Akina Pharmacy, the shared purpose that drives us is to enrich the lives of the people in our care through compounded... ..., we embrace the Entrepreneurial Operating System (EOS) to ensure our success by prioritizing the recruitment...Contract workTemporary workRemote workTrial period
$130k - $160k
Crosby Legal, Inc. is seeking a People Operations Lead to design and execute people operations including hiring and onboarding. The ideal... ...excellence. Responsibilities include developing efficient HR systems and ensuring compliance with employment laws. The role offers...$153.72k - $230.58k
...part the Mount Sinai Pharmacy team and on behalf of... ...supporting Mount Sinai Health System. Responsibilities... ...analysis of pharmacy claims utilization in order... ...support clients. Operational understanding and competence... ...of nursing, and a leading school of medicine and...ClaimsFull timeTraineeshipLocal area
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