Client Operations Manager - Medicare

As a Client Operations Manager focused on Medicare, you'll be at the forefront of delivering seamless client experiences by managing benefit changes, implementing new plans, and ensuring pricing accuracy-all while driving impactful solutions that directly shape business success. You'll lead key quality assurance initiatives, proactively identify claim discrepancies, and collaborate across teams to streamline processes, making a tangible impact on client satisfaction and operational efficiency. Your expertise will be essential in shaping client strategies, resolving complex issues, and upholding the values that keep Capital Rx ahead of the competition.

Position Responsibilities:

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  Support implementation and client management teams with all day-to-day client requirements

  
  

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  Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations

  
  

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  Analyze incoming client requests and work with internal and external teams to complete required plan documentation

  
  

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  Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent

  
  

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  Lead pre- and post-implementation quality assurance and testing to validate coding accuracy

  
  

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  Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address

  
  

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  Handle and resolve sponsor and member issues, escalating as needed

  
  

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  Research and respond to claims processing and system configuration inquiries

  
  

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  Coordinate integration of other data inputs into client management processes

  
  

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  Collaborate cross functionally to support general client operations, as required

  
  

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  Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

  
  

Required Qualifications:

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  Bachelor's Degree preferred, or equivalent combination of education, training, and experience

  
  

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  2+ years of proven experience in PBM / health plan, benefits consulting, or healthcare

  
  

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  Health Plan experience required

  
  

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  Track record of building trusting internal and external relationships

  
  

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  Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables

  
  

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  Medicaid experience required

  
  

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  Experience working with structured and unstructured data

  
  

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  Proficient in Microsoft Office, SQL a bonus

  
  

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  Ability to balance multiple complex projects simultaneously

  
  

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  Exceptional written and verbal communication skills

  
  

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  Extremely flexible, highly organized, and able to shift priorities easily

  
  

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  Attention to detail & commitment to delivering high quality work product

  
  

Base Salary: $80,000 - $100,000

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.