Director, Data Exchanges

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

• Owner of all client data exchanges for inbound and outbound file transfers including eligibility, prior authorizations, claim history, accumulation balances and reconciliation, claim extracts and billing reconciliation.
• Responsible for driving data exchange implementation across internal and technical teams; document and train team members on troubleshooting basic to medium complexity challenges prior to escalating. 
• Serve as point of escalation for all files issues and defining requirements for solution with IT by identifying the root cause, triage and supporting resolution of all errors of transferring and loading of files.
• Request, validate and confirm full file data feeds from clients to ensure system integrity through regular audits and reconciliation; communicate directly with third party vendors for data exchange set ups and troubleshooting.
• Lead the design of all new file management systems including all vendors, client migrations, and existing client add-on projects.

Qualifications / Profile:

• Bachelor’s degree
• 4+ yrs of PBM / health plan experience in eligibility, file feeds, accumulator or other relevant experience.
• Ability to match PBM concepts and data fields across various systems to ensure a match and accuracy of data transfers.
• Proven track record of developing processes to manage setup, testing and maintenance of critical operational tasks.
• Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders.