Sr. Claims Specialist AstraZenecaLocation: Wilmington, Delaware, United States
Job reference: R-015426
Posted date: Oct. 11, 2017
At AstraZeneca we turn ideas into life changing medicines. Working here means being entrepreneurial, thinking big and working together to make the impossible a reality. We’re focused on the potential of science to address the unmet needs of patients around the world. We commit to those areas where we think we can really change the course of medicine and bring big new ideas to life. As Senior Claims Specialist in Wilmington, DE you’ll play a pivotal role in channeling our scientific capabilities to make a positive impact on changing patients’ lives. North American Commercial is the ‘face’ of AstraZeneca and MedImmune to our many healthcare clients. They represent many of the most well recognized and respected products in the industry, and build strong relationships with healthcare professionals.
The Claims Specialist is responsible for working with internal/external customers on the receipt, analysis, impact, resolution and posting/reporting of all contractual payments across multiple customer segments including Health Plans, PBMs, Part D, GPOs, Wholesalers, and State and Federal Government as well as maintaining all related documentation for those payments. In this role, the incumbents manage and meet deliverables of business operations to monitor, evaluate and administer claims to be paid and ensure payments are accurate, timely, formulary compliant and entered in contract systems consistent with agreement terms, following corporate controls/approved guidelines and SOX regulations. Incumbents will also be expected to establish and maintain collaborative working relationships with internal/external contacts and peers to ensure effective communication and a high-level of customer service to support successful implementation and execution of contract terms. Incumbents are responsible for exercising judgment in unclear business situations with multiple competing priorities under tight deadlines with high- impact risk of error to company financials. Incumbents must exercise judgment within defined procedures and practices to determine appropriate action steps necessary to ensure accurate claims processing. Incumbents must also possess an in-depth knowledge of claims processes, systems and an understanding of MMO contracting processes and strategies to ensure contract compliance. Incumbents will be expected to participate in cross-functional projects within MMO as identified by management.
The Claims Specialist is responsible for processing, monitoring, reviewing, measuring, tracking, validating, researching, analyzing and reporting on customer activity/utilization reported by contract customers, wholesalers, state and federal government, and others using chargebacks, rebates and sales data. Understanding and interpreting contract language and regulations as it relates to contract setup and maintenance to ensure accurate calculation of customer reimbursements. Developing and maintaining strong working relationships to facilitate the exchange of key information, understand and address needs, and clarify contract requirements with internal and external customers.
Additionally, the Claims Specialist is responsible for collaborating with peers to manage priorities and coordinate efforts with a focus on providing excellent customer service. Contributing to contract management and strategy approaches through knowledge of reimbursement arrangements and potential business operations capabilities. Meeting and understanding all compliance-related requirements such as completion of mandatory training, adherence to audit controls, and adherence to all AZ policies, SOPs, job aids, and Sarbanes-Oxley requirements. Participating on cross-functional teams lending support and input from a Managed Markets Operations perspective as well as special projects as assigned by management.
Senior Level Responsibilities:
The Senior Claims Specialist, in addition to the Claims Specialist responsibilities above, is distinguished by the difficulty of assignments as well as an increased level of expectation as it relates to the negotiation, analysis, development, and administration of contracts. The Senior Claims Specialist incumbent encompasses the following characteristics consistently on a daily basis within all of their responsibilities: high performer, high productivity, consistency, accountability, leadership skills and proactive/big picture thinker. The Senior Claims Specialist is skilled at multi-tasking and as a result capable of processing any and all types of claims on a daily basis. In addition to the Claims Specialist responsibilities, the employee will become more involved in assisting management on special projects and issue/problem resolution, often times taking on a leadership role and may be called upon to oversee a specific subset of claims functions. In addition, senior level employees serve as leaders among their peers and are viewed as the “go-to” person both within their respective teams as well as cross department. Additionally, an employee in this role must:
- Develop and communicate reporting techniques/tools emphasizing trend analysis as it relates to strategy development, contract performance, and compliance
- Proactively seeks and recommends enhancements and improvements in MMO claims processes, including recommending resources, new approaches, negotiating agreeable solutions, or involving next-level management as needed
- Serve as a mentor to those at the Claims Specialist level, helping them to prioritize workload and understand individual customer needs and expectations
- Leverage business expertise, knowledge of the pharmaceutical industry, past experience to address business issues and opportunities
- High level of attention to detail in order to successfully process and assume accountability for a portion of multi-billion dollars in annual customer payments
- Ability to multitask and prioritize in order to meet strict deadlines while providing exceptional customer support
- Strong analytical and problem solving skills
- Strong communication skills, both oral and written
- Strong organizational and time management skills
- Requires a high level of initiative, independence and teamwork
- Ability to utilize office software to work with spreadsheets, databases, and decision support and query tools, specifically MS Excel and MS Word
- Ability to manage daily workload as well as special assignments and projects
- Demonstrated high level of professionalism
- Flexibility with schedule, when needed, to work during peak times that may require work hours outside of normal working hours
- Bachelor’s Degree in a business related field (Accounting, Finance, Economics and/or Health Care)
- 3-5 years in a related business environment
- Incumbent should have a general understanding of AstraZeneca’s product line and the various contracting strategies deployed across assigned markets
- Previous experience working in Managed Markets or the healthcare industry
- Knowledge of the pharmaceutical contracting process
Key Leadership Capabilities:
- Engages with internal and external customers through communication vehicles to better understand underlying issues/needs and proactively/consistently develops solutions, products or services
- Ability to think strategically and think broadly, but also identifies opportunities and develops solutions
- Works collaboratively by respecting and integrating diverse views into decisions/proposals; Works as an individual contributor to accomplish team goals and to support goals of others
- Drives performance by anticipating and/or removing obstacles for others in order to deliver results and succeed
- Acts decisively and makes effective decisions or uses appropriate judgment, as necessary, when confronted with incomplete information in a fast paced environment
Next Steps -- Apply today!
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AstraZeneca is an equal opportunity employer. AstraZeneca will consider all qualified applicants for employment without discrimination on grounds of disability, sex or sexual orientation, pregnancy or maternity leave status, race or national or ethnic origin, age, religion or belief, gender identity or re- assignment, marital or civil partnership status, protected veteran status (if applicable) or any other characteristic protected by law. AstraZeneca only employs individuals with the right to work in the country/ies where the role is advertised.