Director, Rx Operations
The Director, Rx Operations is responsible to define and document case benefit requirements with input from Relationship Managers, implement with Envision and AmWINS departments (reporting, clinical, Quality Assurance, PDP), manage plan changes as requested, manage issues as identified and resolve per client expectations. The position will be the primary point of contact for Envision benefit setup and claims processing issues, and will support AmWINS (Contact Center, sales and account management, Reporting and IT, Finance) for any claim processing and calculation issues.
The Director closely collaborates with the Sales and Finance functions to maintain a best-in-class Rx organization that successfully services, with high quality, the remainder of the Company and external parties and fosters Company growth.
Group Implementation and Maintenance
- Work with Relationship Managers to define benefit plans for commercial and Medicare Part D plans
- Understand provider price schedules to insure claims accuracy
- Work with claims adjudication vendor on errors or issues in the system, also meet on upcoming changes
- Research and assist with Medicare identified claim errors (PDEs) as provided by Quality Assurance area
- Define process, procedures, and quality assurance requirements for successful claims system operation, and work with Quality Assurance to insure implantation is error free
- Work with Sales and relationship management to define standard 5-8 benefit plan offerings (Goal: 75% of new business will adhere to standard offering)
- Implement that standard plans in the system so they are ready to use for quick implementation
- Work with Marketing to create all marketing materials
- Work with Finance and management to set standard costs for each product line
- Work with Reporting/IT to create standard reporting and sales reports (formulary and network disruption analysis, repricing analysis, etc.)
- Define Sales talking points and value-add materials (Est costs, savings, disruption analysis)
- Rollout standard product to Sales
- Contact point for escalated items with claim system
- Promote positive working environment
- Performance coach, manage, and evaluate staff
Bachelor's in Operations, Project Management, or Health Care related field plus 5 years related experience, or equivalent combination of education and experience. Group Benefit insurance or pharmacy background preferred. Strong knowledge of pharmacy benefit management, claims administration, retail pharmacy operations, Medicare D, reinsurance, and underwriting is preferred. At least five years' experience in a culture-centric environment is desired.
- Data analysis and related analytical tool skills (Access, Excel)
- Experience with administrative systems and familiarity with industry technology solutions
- Prior management of systems and data conversions and related projects
- Ability to provide guidance to IT management and personnel
- Advanced skills in Microsoft Office products with emphasis on Excel, Word and Access
Leadership: visionary leadership; culture driven; change management; managing people; ethics
Intellectual: analytical skills; design skills; technical skills; problem solving skills; project management skills.
Interpersonal: exceptional customer service skills; interpersonal skills; professional oral and written communication skills; teamwork.
Organization: business acumen; cost consciousness; ethics; organization support; strategic thinking.
Self-Management: sound judgment; planning and organizing skills; professionalism; agility; open-mindedness; dependability; initiative.Company Description AmWINS Group, Inc. has been a leader in the wholesale insurance industry since its formation in 1998. The firm is headquartered in Charlotte, North Carolina and has nearly 100 locations around the world. The firm has expertise across a diversified mix of property, casualty and group benefits products. AmWINS also offers value-added services to support some of these products, including product development, underwriting, premium and claims administration and actuarial services.
With more than 3,600 employees, AmWINS is an amalgamation of 35+ wholesale brokerage, underwriting and group benefit operations which have been acquired over the course of 12 years. The firm currently receives more than 675,000 submissions a year from retail insurance agents across the United States. More than $11.1 billion in premium placements makes AmWINS the largest wholesale broker in the U.S. as ranked by Business Insurance magazine. AmWINS has extensive relationships with more than 20,000 retail insurance brokerage firms and more than 800 insurance underwriting firms