Copay Manager - Support Program / Claims Processing (Orlando)

Copay Support Program Manager

The Copay Support Program Manager is a critical role within the organization and is primarily responsible for the creation, design, set-up and administration of Pharmacy and Medical Copay programs for AssistRx manufacturer clients. Required engagement with client, account managers, program managers, finance team members and other departments within the organization to implement and support all operational and financial processes related to claim processing activities. In addition, manager will ensure effective day-to-day operations and provide ongoing Copay program metrics for internal and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances as well as replenishment needs. This position will identify and report Copay trends, patterns and behaviors as well as make recommendations to increase utilization based on Copay claims and patient compliance / adherence activities. Also, this position will implement data-driven initiatives to achieve operational and process excellence that will optimize and increase the number of Copay Programs supported and managed by AssistRx.

The Global Copay Program Manager will serve as the primary client contact for developing, implementing, enhancing, and managing pharmaceutical Copay programs.

Primary Patient Solutions contact assisting in affordability program design, affordability program business rules determination, set-up and maintenance of Copay programs and other AssistRx adjudicated program offerings.

Support the development and implementation of existing and new Copay programs including troubleshooting, communicating with internal program leaders, program vendor(s), administrator(s), pharmacies, sites of care as well as patients.

Partner with internal and external stakeholders with respect to program design, program improvements and / or changes.

Define and execute the work plan for program staff.

Manage the day-to-day activity of the program(s) and supervising the Copay team.

Maintains a great work environment by teaching, training, developing and coaching HUB personnel on Copay programs and claim adjudication troubleshooting.

Have significant participation in programs' strategic planning and be accountable for proper execution of contract terms for assigned program(s).

Manage the client relationship, gaining trust and building rapport.

Work cross-functionally with internal stakeholders for successful program operations.

Participate with Hub Services leadership and client team on initiatives to improve process and performance.

Gains a thorough understanding of the adjudication claims engines and networks, including the variation of system logics across multiple adjudicators.

Must be proficient in accessing data from affordability program platforms and being able to analyze its significance regarding the functioning of a program's business rules.

Responds to and resolves business rule questions or concerns escalated from internal teams or adjudicators.

Responsible for performing quality control on new Copay program set-ups and any requested updates.

Develops reports reflecting Copay claim activities and provides to the business leaders for presentation to the clients.

Participates in client facing calls and internal training presentations as the need arises.

Uses appropriate measurement, analysis and evaluation methods to accurately identify and document improvements.

Partners with finance team on Copay claim billing and escrow balances.

Responsible for data integrity.

Acts as a Subject Matter Expert and key contributor on complex or critical assignments, related to Copay and / or other affordability programs.

Performs other related duties as assigned by management.