Pharmacy Claims Lead

SS&C Technologies

. Provide strategic and operational leadership for pharmacy claims adjudication, configuration, and oversight .

Posted 9/15/2026full-timeKentucky • United StatesSenior💰 $120,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy claims adjudication, configuration, and operational leadership, with a strong focus on performance measurement, compliance adherence, and team development. Proficient in data analysis and stakeholder management to drive operational improvements and strategic initiatives.

Highest-signal resume keywords

Pharmacy Claims AdjudicationOperational LeadershipData AnalysisSQL ProficiencyCompliance Adherence

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy ClaimsClaims ConfigurationRoot Cause AnalysisPerformance MeasurementOperational MetricsException ManagementWorkflow OptimizationSystem ModernizationData InterpretationAudit Readiness

Soft Skills

LeadershipStakeholder ManagementProblem-SolvingAdaptabilityTeam Development

Tools & Technologies

ExcelOperational Dashboards

Industry Keywords

HealthcarePharmacy OperationsPBM OperationsRegulatory ComplianceContractual Requirements

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Provide strategic and operational leadership for pharmacy claims adjudication, configuration, and oversight
Own the integrity and performance of pharmacy claims functionality across Commercial, Medicare, and Medicaid lines of business
Lead, coach, and develop a team responsible for pharmacy claims configuration, validation, monitoring, and issue resolution
Establish performance expectations tied to claims accuracy, processing quality, system reliability, and service-level attainment
Prioritize work across competing demands and focus the team on high-impact activities
Own pharmacy claims adjudication logic and operational behavior, including Transition and Long Term Care (LTC)
Ensure claims configuration and system rules are implemented, tested, and continuously validated
Monitor claims performance and system outputs to identify defects, anomalies, and downstream impacts
Drive complex issue resolution through root cause analysis
Develop and maintain operational dashboards and metrics tracking claims performance, financial accuracy, and compliance adherence
Use data to detect trends, identify risks, and drive corrective action
Ensure adherence to federal, state, and contractual requirements
Support audit readiness through documentation, traceability of logic, and system-behavior validation
Serve as the functional authority for pharmacy claims logic and adjudication behavior
Partner with business, compliance, clinical, and technology teams to translate requirements into system configuration and measurable outcomes
Lead initiatives modernizing claims operations, reducing manual work, improving configuration governance, and enhancing monitoring

Requirements

What you’ll need

Demonstrated leadership experience in a complex operational or systems environment, including direct people management or equivalent leadership responsibility
Experience leading teams responsible for configuration, validation, monitoring, or operational control functions
Strong analytical capability, including ability to interpret data, identify patterns, and drive action
Experience with operational metrics, reporting, and performance measurement
Proficiency with Excel and SQL
Ability to work with structured data and translate it into insights
Strong stakeholder management across technical and business domains
Ability to lead through ambiguity, change, and evolving operating models
Strong problem-solving skills with emphasis on root cause analysis and prevention
Bachelor’s degree or equivalent experience in healthcare, pharmacy operations, or related field
Experience in pharmacy claims, PBM operations, or adjudication systems
Experience in highly regulated environments with accountability for compliance and audit outcomes
Exposure to automation, workflow optimization, or system modernization initiatives
Experience with claims monitoring, exception management, or controls frameworks
Project leadership experience in cross-functional environments

Benefits

Comp & perks

Hybrid Work Model and business casual dress code, including jeans
401k Matching Program
Professional Development Reimbursement
Flexible Personal/Vacation Time Off
Sick Leave
Paid Holidays
Medical, Dental, and Vision coverage
Employee Assistance Program
Parental Leave
Hands-on, team-customized training, including SS&C University
Discounts on fitness clubs, travel, and more
Discretionary annual bonus and/or equity awards, such as restricted stock units or stock options, subject to individual and business performance