Position Description:

This Manager role is a critical position for Financial Operations and will be responsible for streamlining and executing invoicing for the following “non-standard” (non-PBM/PBA) lines of business: Capital Risk Management, Capital Equilibrium, Judi Care, Judi Group, Prime, and PIC. This role will partner internally and externally to ensure alignment on billing requirements and invoice specifications. This role will be an instrumental team player that will drive billing and reconciliation process improvement across all non-standard lines of business. The individual must have a strong financial background in PBM and be comfortable working with Excel and SQL formulas to efficiently run processes

Position Responsibilities:

• Billing Operations & Data Analysis
  • Lead comprehensive billing processes by analyzing inbound data from multiple sources, including multi-year contracts, client programs, and service volumes (e.g., per claim, per member, one-time fees, recurring fees)
  • Manage billing across various lines of business including commercial, public, private, and government health plans, covering drug spend and ancillary services
• Data Validation: Verify month-over-month data consistency across multiple sources
  • Research discrepancies for root cause
• System Reconciliation: Reconcile billing records between internal platforms (e.g., ERP and adjudication systems) to ensure consistency
• Contract Review: Review internal documentation to confirm billable items are correctly captured
• Process Adherence: Follow established billing procedures and escalate discrepancies to senior finance staff
• Continuous Improvement & Collaboration with a focus on automation
• Utilize SQL or other data query applications to prepare journal entries, accruals, and adjustments as required

Required Qualifications:

• 2+ years Health Care experience, inclusive of premium billing, self-funded, EGWP
• 2+ years of related experience in finance, data analysis, or accounting
• Undergraduate bachelor’s degree in Business, Finance, or quantitative field
• Strong Excel and SQL Skills
• Ability to challenge and improve existing processes through automation and redesign
• Motivated team player with the ability to work in a fast-paced, forward-moving environment
• Attention to detail & commitment to delivering high quality work
• Passion for healthcare and for driving lasting change in health and pharmacy benefits
• Ability to define problems, collect data, establish facts, solve problems, make recommendations, and draw valid conclusions in a timely and accurate manner