Manager, Claims

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. 

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.   

We are seeking team members who:

Are inspired and compassionate problem solvers;

Produce high quality work; 

Thrive in the excitement of the ever-challenging environment of modern medicine; and 

Are committed to achieving superior health outcomes for people living with rare and devastating diseases. 

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.  

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location: Pittsburgh, PA

Classification: Exempt

Job Type: Full-Time

Reports To: Sr Mgr Referral Services

Job Description:

The Manager, Claims provides oversight of all operational aspects of the Claims Analyst function, which includes staffing. This role implements and oversees of day-to-day operations of assigned therapy teams to ensure drugs are managed in a consistent manner that embraces Panther’s RxARECARE patient-centered service excellence and quality. This position ensures the designed RxARECARE program is executed, while demonstrating strong financial stewardship. The Manager, Claims provides operational direction to Supervisors over the claims analyst staff that support the insurance verification and billing processes and procedures to ensure key quality performance indicators are in line with company goals. 

Responsibilities:

• Provides strategic planning and direction to ensure goals for the department are met by specified targeted dates.
• Creates and fosters a work environment that encourages productivity and work loyalty and employee satisfaction. 
• Works closely with cross functional teams on initiatives, process improvements, and problem solving.
• Serves as liaison/mentor to the department.
• Provides leadership, coaching and feedback as needed. Conducts weekly meetings with direct reports.
• Assists supervisors with review of department productivity dashboard reports to evaluate work performance timely to identify strengths and weaknesses within the department. Assists with disciplinary measures as needed.
• Monitors and maintains appropriate staffing levels to manage the book of business assigned to ensure tasks are done timely and accurately.
• Reviews and monitors daily phone logs to ensure adequate staffing is present to handle call volumes.
• Evaluates opportunities to automate work functions to reduce cost of doing business associated with labor costs.
• Develops and maintains SOP’s for the department to ensure internal controls and policies are being adhered to.
• Looks for strategic approaches to solve for long term growth.
• Attends manufacturer meetings and/or calls as needed.
• Assists with the implementation and roll out of new processes.
• Participates in the interview process to evaluate potential new candidates.
• Abilities to handle multiple tasks and meet deadlines.
• Assists with the management of all assigned projects impacting the Claims Analyst teams.
• Other duties as assigned within scope of practice.

Required Qualifications:

• Bachelor’s degree in business or related field required. Equivalent work experience may substitute education requirements.
• Detailed understanding of both Medical and Pharmacy insurance verification processes with all payer types.
• Excellent oral and written communication skills and able to communicate effectively with all levels of management.
• Strong problem-solving skills in order to evaluate all aspects of a problem or opportunity and draw valid conclusions to make appropriate and timely decisions.
• Knowledge of Microsoft Office Suite, especially Excel, Outlook, and PowerPoint.
• Uses tact, sensitivity, sound judgement, and a professional attitude constantly. 

Preferred Qualifications:

• 3 years progressive leadership experience.
• Specialty pharmacy insurance verification knowledge with an emphasis on medical insurance verification including home care nursing a plus.  

Work Environment:

 This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

Benefits:

Hybrid, remote and flexible on-site work schedules are available, based on the position.  PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!   Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.  Of course we offer paid holidays too!

Equal Opportunity:

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.