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Job Snapshot

Employee Type - Full-Time EmployeeEducation - 4 Year DegreeExperience - Not SpecifiedIndustries - Management, Facilities

Description

Are you looking to make a difference in a patient’s life?  At Innomar Strategies, a company of AmerisourceBergen, you will find an innovative culture that is patient focused and dedicated to making a difference.  As an organization, we are united in our responsibility to create healthier futures.


POSITION SUMMARY:

As a member of the Cameron Stewart LifeScience Canada Inc. (CSL) business unit, the Program Operations Manager will manage adjudication operations needs in supporting our card services to meet or exceed client business requirements. This role focuses on overseeing the day to day activities from an adjudication perspective that impacts the design, programming and ongoing execution of the various types of card adjudicated programs that CSL supports for our pharma clients.

This role is well suited to an individual who is keen to grow and learn and one who enjoys challenges and continuous improvement. In this role the successful candidate will be comfortable managing teams, have a strong knowledge and experience with adjudication programming, IT applications, and database development methodology.

PRIMARY DUTIES AND RESPONSIBILITIES:

The primary duties of the role are expected to include, but may not be limited to the following:

Program Support Services

  • Lead the day to day activities that support our back end adjudication requirements – program set up, reporting, price analyses, post claim auditing needs, ongoing management, etc. 
  • Review and assess payment scenarios before they are sent to clients for final approval before implementation
  • Review provincial guidelines, markups, and dispensing fee changes to understand cause and effect for all clients
  • Monitor drug claims and perform audits to ensure adherence to coverage expectations
  • Provide information to patients, pharmacies, and doctors about patient financial assistance programs
  • Liaise with our adjudication partner directly or via automated systems to program new card programs, make changes to existing programs, trouble shoot claim transmissions, and escalation issues
  • Develop new processes and/or enhance existing ones in order to streamline efficiencies and to meet KPIs
  • Develop SOPs that clearly define adjudication operations within CSL
  • Work with claims adjudication and IT vendor partners on implementation and integration of new/existing card and digital programs
  • Identifies and articulates adjudication enhancements required from our adjudication partner
  • Participates in quarterly business review sessions with our adjudicator and actions any follow up items.

Internal Collaboration

  • Work collaboratively with other members of the CSL and Innomar Digital team in the development and implementation of card solutions from an adjudication perspective
  • Work closely with internal departments to ensure programs run successfully and efficiently and ensure all client KPIs are met
  • Participate as subject matter expert in cross functional meetings that plan and execute implementation plans involving our adjudication needs
  • Act as subject matter expert on reimbursement solutions and how they apply to patient financial assistance programs
  • Provide subject matter expertise, business requirements documentation and guide internal and 3rd party vendors towards improving current and developing new solutions to meet the evolving needs of our clients

People and Resource Management

  • Manages a team of adjudication support specialists that will facilitate program set up, reporting, price analyses, post claim auditing needs, and ongoing program management and escalation, etc
  • Provides associate assessment, coaching, and guides development plans and succession planning guidance, along with CSL leadership
  • Leads in the development of budgets and manages resources, projects, and financial requirements that involve the operations supporting our adjudication services 
  • Support ongoing measurement of transaction growth and success against quarterly and yearly targets
  • Manage and support the execution of card program specific tactical plans as needed


EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

  • MBA or Bachelor’s Degree (Business or Science)
  • 5 or more years of experience working for an adjudication provider 
  • Experience in pharmaceutical or private payer sector an asset; with process flow management, operational coordination, people management and data reporting


MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

  • Strong knowledge of claim adjudication, not just claim processing at a pharmacy level, but detailed programming, process flows and adjudication systems
  • Knowledge of the Health Care Sector and Market Access/Reimbursement/private plan design
  • Working knowledge of Medical and Scientific terminology
  • Effective interpersonal and leadership skills 
  • Strong business and project management acumen
  • Ability to analyze, pull through insights, and present outcomes
  • Basic understanding of application and database development methodologies
  • Proficient in MS Excel/Word/Powerpoint with willingness to expand skill set
  • Effective organizational skills; attention to detail
  • Travel less than 10% of the time


We offer competitive total rewards compensation. Our commitment to our associates includes benefit programs that are comprehensive, diverse and designed to meet the various needs across our associate population.


  • Comprehensive health and dental plans
  • Flexible & remote working options
  • Employer RRSP-matching
  • Online peer-to-peer recognition program
  • Corporate discounts with multiple establishments, including fitness centers
  • Health & Wellness program with onsite yoga and massage therapy


Throughout our global footprint and various business units, we take a balanced approach to the benefits we offer. Many benefits are company-paid, while others are available through associate contributions. Specific benefit offerings may vary by location, position and/or business unit.

Innomar Strategies, a part of AmerisourceBergen, is Canada’s leading patient support provider for specialty pharmaceuticals. Through our Integrated Service Model, we deliver customized solutions to improve product access, increase supply chain efficiency, and enhance patient care. Innomar is the trusted expert in specialty pharmaceuticals with an unwavering commitment to patients.



 
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