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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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:

• Establish and oversee relationships with payers, vendors, and internal business process owners to create and sustain viable solutions that support pharmacy claim subrogation activities, functions, and services
• Manage relationships with external constituents and subrogation vendors to establish, enhance, and automate pharmacy claims subrogation processes and functions
• Oversee the exchange and processing of subrogation reimbursement files
• Process subrogation reimbursement files and determine whether subrogation claims will be deemed non-recoverable or recoverable
• Resolve adjudication discrepancies by working with various departments including IT, Account Management, Finance and Client Operations
• Supply comprehensive business insight across subrogation and payment integrity service functions
• Provide leadership/oversight to projects and teams supporting areas of operational accountability

Required Qualifications:

• 5+ years of PBM / health plan experience
• Expertise in payment integrity / pharmacy claims subrogation processes, services, and functions
• Ability to match key PBM claims concepts and data various systems and file layouts to ensure consistency and accuracy of outcomes
• Proven track record of execution in an operations environment
• Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
• Self-motivated and detail-oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.