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As a leading financial services and healthcare technology company based on revenue, SS&C is headquartered in Windsor, Connecticut, and has 27,000+ employees in 35 countries. Some 20,000 financial services and healthcare organizations, from the world's largest companies to small and mid-market firms, rely on SS&C for expertise, scale, and technology.
Job Description
What You Will Get To Do:
As a Senior Pharmacy Claims Professional, you will take ownership of critical processes to ensure accuracy and compliance for pharmacy point-of-sale Coordination of Benefits (COB) adjudicated claims. In this role, you will analyze complex issues, evaluate multiple variables, and contribute to shaping departmental strategy. Your expertise in data analysis, problem-solving, and regulatory compliance will be key to driving process improvements and delivering exceptional results.
Serve as a subject matter expert for pharmacy COB processes and claims processing logic.
Analyze, monitor, and enhance processes and adjudication logic for pharmacy COB point-of-sale claims.
Lead projects related to process or logic changes across internal and external areas.
Create, update, and maintain reports, policies, and procedure documents.
Maintain compliance with all federal and state requirements.
Participate in CMS program audits and internal mock audits.
Collaborate with internal and external partners on cross-functional project teams to identify impacts, define requirements, and conduct end-to-end testing.
Exercise considerable latitude in determining objectives and approaches to assignments.
Act as the subject matter expert for User Acceptance Testing (UAT) in COB claims processing, checking that systems work correctly and deliver quality results.
Perform other duties as assigned.
What you will Bring:
Proven experience with Coordination of Benefits (COB) processes and pharmacy claims adjudication.
Familiarity with CMS Prescription Drug Manuals used for COB Claims Processing, and ability to interpret and apply federal and state requirements.
3–5 years of experience in data analysis and problem-solving for process and workflow optimization.
Proficiency in Microsoft Office applications (Access, Word, Excel, PowerPoint).
Excellent communication, teamwork, and organizational skills, with proven ability to build strong relationships, consult effectively, and influence stakeholders across teams.
Ability to manage multiple priorities, meet deadlines, and thrive in a fast-paced, dynamic environment.
Superior attention to detail and analytical skills for identifying and resolving complex issues.
Demonstrated accountability, adaptability, and ownership of deliverables.
Not Required But Will Set You Apart:
Hands-on experience with project testing, including scenario building.
Proven background in process engineering and workflow improvement.
Working knowledge of SQL and ad-hoc query tools for data extraction and manipulation.
Experience with pharmacy point-of-sale (POS) logic and real-time adjudication processes.
Unless explicitly requested or approached by SS&C Technologies, Inc. or any of its affiliated companies, the company will not accept unsolicited resumes from headhunters, recruitment agencies, or fee-based recruitment services.
SS&C offers excellent benefits including health, dental, 401k plan, tuition and professional development reimbursement plan. SS&C Technologies is an Equal Employment Opportunity employer and does not discriminate against any applicant for employment or employee on the basis of race, color, religious creed, gender, age, marital status, sexual orientation, national origin, disability, veteran status or any other classification protected by applicable discrimination laws.
Salary is determined by various factors including, but not limited to, relevant work experience, job related knowledge, skills, abilities, business needs, and geographic regions.Jersey City, NJ: Salary range for the position: 85,000 USD to 100,000 USD. NY: Salary range for the position: 85,000 USD to 100,000 USD. Colorado: Salary range for the position: 85,000 USD to 100,000 USD. Originally posted on Himalayas
