Finance Manager (Remote in US)

About the position Responsibilities • Lead and manage all contract requirements, ensuring adherence to service level agreements (SLAs) and operational timelines. • Oversee and perform day-to-day financial activities associated with pharmacy claims and fee-for-service claims adjudication. • Oversee provider recoupment processes and weekly payment cycle operations, ensuring timely and accurate disbursements. • Manage and coordinate non-risk payment process involving managed care. • Perform quality assurance activities involving fee-for-service RX, SPBM, Med-dent, and capitation payment cycles. • Act as the primary point-of-contact for pharmacy and fee-for-service claim payment financial topics for the client and stakeholders. • Contribute to financial related client and stakeholder communications, outreach, and strategies. • Update pharmacy and fee-for-service claim payment procedures and associated materials, including policies and procedures, desk-level procedures, and manuals. • Manage escalated tickets, providing swift and appropriate resolution while maintaining high client satisfaction. • Direct the end-to-end medical claims and single pharmacy benefit claims management processes. • Collaborate closely with the state client and external vendors to maintain compliance and operational excellence. • Establish and foster a high-performance team environment focused on accountability, results, and continuous improvement. • Provide clear leadership in managing people, driving team development, and nurturing a culture of excellence. • Demonstrate advanced knowledge of business operations, finance, and technical processes to support administrative functions and cross-functional collaboration. • Proactively identify and pursue business opportunities while resolving complex financial and operational issues, especially within claims management. • Ensure compliance with all applicable federal, state, and local regulations related to finance and claims processing. Requirements • Bachelor's degree in finance, Accounting, Business Administration, or a related field (master's degree preferred). • 5+ years of experience in a leadership or managerial role in healthcare finance operations (required). • Proven experience managing remote teams and creating productive, collaborative remote work environments (preferred). • Strong knowledge of claims processing, particularly medical and pharmacy claims. • Medicaid and PBM claims experience (preferred). • Experience managing vendor relationships and working directly with government clients is highly preferred. • Exceptional organizational, analytical, and communication skills. Nice-to-haves • Experience with using Vue360 and/or Vue360Rx. • Ability to create and analyze data using SQL. • Functional knowledge of Service Now (required). • Functional knowledge of Flexi or other payment gateway systems (required). • Functional knowledge of Administrator (required). • Functional knowledge of Cypress (preferred). • Functional knowledge of Letter Manager (preferred). • Functional knowledge of Report Manager (preferred). • Functional knowledge of Citrix (preferred). • Functional knowledge of Remote Desktop for servers (preferred). Benefits • Health (medical, dental, vision) benefits start on day 1 of employment. • Company match 401K and other benefits available within months of starting. • Employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. • Company provided computer for work use. Apply tot his job Apply To this Job