Specialist, Managed Care Operation

Job title: Specialist, Managed Care Operation

• Location: Morristown, US

About the Job

The Managed Care Specialist is responsible for contract management for various markets including Commercial Contracts, Medicare Part D and Managed Medicaid.   This position will support National Pharmaceutical Benefit Manager (PBM) customers.  Responsibilities include timely and accurate loading of contracts and amendments, eligibility, and adjudicating payments in accordance with contracted terms and conditions across Sanofi’s pharmaceutical portfolio in multiple systems including ECP (Electronic Claims Processor) and Revenue Manager (Model N administration system). 

This position will analyze and pay rebates based on contract language, formulary placement and utilization management policies.  The candidate will have a fundamental understanding of contract strategies, markets and Sanofi products and will prepare invoice payment results providing insights and feedback on trends and issues.  The Specialist will work in close cooperation with Managed Care Operations colleagues and counterparts in Contract Development, the Account team, Legal, Pricing & Analytics and Digital. 

Join the team transforming care for people with immune challenges, rare diseases, cancers, and neurological conditions. In Specialty Care, you’ll help deliver breakthrough treatments that bring hope to patients with some of the highest unmet needs.

About Sanofi: 

We are an R&D-driven, AI-powered biopharma company committed to improving people’s lives and delivering compelling growth. Our deep understanding of the immune system – and innovative pipeline – enables us to invent medicines and vaccines that treat and protect millions of people around the world. Together, we chase the miracles of science to improve people’s lives.

Main Responsibilities

• Manage all aspects of contracts of the assigned PBM/payor including fully understanding the terms and conditions to appropriately set up contracts, update for contract amendments and adjudicate claims accurately.  Illustrate deep understanding of the contract and be able to effectively interpret and analyze key components of the contract. 

• Analyze rebate payments utilizing reporting tools and third party data sources illustrate rebates and market share trends.  Robust understanding and analysis of variances vs. prior periods.  Provide meaningful, concise trending and variance commentary to Senior Management as needed. 

• Cross functional communication with Contract Development and Account teams, ensuring understanding and awareness of customer issues. 

• Ensure accuracy of system validations including 340B

• Verify that all product and eligible members comply with contract requirements

• Analyze product formulary placement and utilization management policy to ensure appropriate contract tier placement and rebate payment.

• Extensive interaction with both external customers and key internal stakeholders to resolve any data discrepancies

• Analyze contract exceptions for interpretation in the system(s) for accuracy of calculations/process compliance

• Ensure all payments are fully compliant with the terms of the contract

• Provide accurate 3 month rolling Cash Flow forecast for customers

• Participate in ad hoc projects 

About You

Required Experience:

• Bachelor’s Degree (Accounting, Economics, Finance or Business are preferred)

• Strong oral and written communication skills

• Professional manner and tact

• Organized, accurate and detail oriented, disciplined and dedicated to superior quality work

• Strong sense of commitment and teamwork

• Ability to work independently

• Ability to multi-task and meet established deadlines

Preferred Experience:

• 1-3 years of work experience preferred

• Strong Excel skills

• Model N experience

• Deep analytical skills and ability to dissect the intricate reasons of rebate trends and variances

• Ability to clearly communicate analysis to the business parties

• Independent problem solving and leadership skills in managing the account

• Proficient in Microsoft Office Tools

All compensation will be determined commensurate with demonstrated experience. Employees may be eligible to participate in Company employee benefit programs, and additional benefits information can be found here.