Agile Product Manager

Streamlining Operations : Improving the efficiency of pharmacy benefit processes to reduce costs and enhance service delivery.


Optimizing Access : Ensuring that members have better access to necessary medications through improved formulary management and network optimization.


Advanced Analytics : Leveraging data insights to drive better decision-making and outcomes in medication management.


Regulatory Compliance : Ensuring that all processes and services comply with relevant healthcare regulations and standards.

Pharmacy CLAIMS experience is a MUST

Duties :

• Specializing in Pharmacy Benefits Management (PBM) Claims adjudication with a broad breadth of industry knowledge across various lines of business and claims processing components.
• Knowledge across multiple lines of business, including commercial, Medicare, and Medicaid.
• Proficient in all components of claims processing, such as eligibility verification, formulary management, pricing, and reimbursement.
• Adept at navigating complex regulatory environments and ensuring compliance with industry standards.
• Skilled in leveraging data analytics to optimize claims processing efficiency and improve overall outcomes.
• Agile Product Management serves as the voice of the client & member.
• Defines system features and participates in validation.
• Responsible for the scope of work within PBM, following client's Agile processes.
• Works through vision & roadmap the Agile Release Train (ART).
• Must be aware of other work being completed within the Portfolio so that they can help teams proactively manage risks and dependencies.
• The incumbent provides counsel and advice to top management on significant matters, often requiring coordination between organizations.
• Focuses on providing thought leadership and technical expertise across multiple disciplines.

Recognized internally as "the go-to person"; for the most complex assignments.