PBM Contract Compliance Expert
3 weeks ago
About Us
">Secure Eclaims LLC is a leading specialty benefits management company in Puerto Rico and South Florida, committed to delivering high-quality, cost-effective care through our innovative care management model.
Job Overview
">We are seeking an experienced Pharmacy Benefit Audit Analyst to join our team. This role requires a strong understanding of PBM contracts, plan design documents, and compliance models.
Key Responsibilities:
">- ">
- Review and analyze PBM contracts to ensure compliance with regulatory requirements.">
- Develop and implement a Compliance Model to calculate client contractual financial guarantees and admin fees.">
- Collaborate with account management and pharmacy consultants to discuss results with clients and vendors.">
- Provide documentation during follow-up negotiations and discussions.">
- Work with IT to further develop Compliance Model logic and capabilities.">
Requirements:
">To succeed in this role, you will need:
">- ">
- A Bachelor's degree in Business, Finance, or a related field.">
- At least 3 years of experience in pharmacy benefit audit or claim adjudication research on one or more PBM platforms.">
- A working knowledge of the PBM industry and pharmacy benefit claims.">
Why Join Our Team?
">As a member of our team, you will have the opportunity to work with a dynamic and supportive group of professionals who are passionate about improving healthcare outcomes and achieving substantial savings for our clients.
Salary:
">The estimated salary for this role is $65,000 - $85,000 per year, depending on experience.
-
Pharmacy Benefit Audit Expert
3 weeks ago
Miami, Florida, United States Secure Eclaims LLC Full timeAbout Secure Eclaims LLCSecure Eclaims LLC is a leading benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors, and members to ensure high-quality, cost-effective care while achieving substantial cost savings.Job Description:We are seeking a Pharmacy Benefit Audit Expert to...
-
Pharmacy Benefit Audit Expert
7 hours ago
Miami, Florida, United States Secure Eclaims LLC Full timeJob DescriptionOur company, Secure Eclaims LLC, is seeking a highly skilled Pharmacy Benefit Audit Analyst to join our team. The ideal candidate will have a strong background in pharmacy benefit auditing and a passion for delivering high-quality results.The primary responsibilities of this role include:Reviewing and understanding PBM contracts for all...
-
Pharmacy Benefit Audit Analyst Expert
3 weeks ago
Miami, Florida, United States Secure Eclaims LLC Full timeJob SummaryWe are seeking a highly skilled Pharmacy Benefit Audit Analyst to join our team at Secure Eclaims LLC. This role involves conducting thorough audits of pharmacy benefit management contracts to ensure compliance and accuracy.The ideal candidate will have a strong background in pharmacy benefit auditing, with experience working with PBM platforms...
-
Healthcare Claims Auditor
3 weeks ago
Miami, Florida, United States Secure Eclaims LLC Full timeAbout Secure Eclaims LLCSecure Eclaims LLC is a top benefits management company in Puerto Rico and South Florida, known for its innovative care management model that integrates provider, payor, and member needs to deliver high-quality, cost-effective care while achieving significant cost savings.Job Summary:We're looking for a skilled Healthcare Claims...
-
Regulatory Compliance Expert
2 weeks ago
Miami, Florida, United States VIVEX BIOLOGICS INC Full timeCompliance Expert PositionVIVEX BIOLOGICS INC is looking for an experienced Regulatory Compliance Expert to join our quality team. In this role, you will be responsible for ensuring compliance with current site SOPs, Corporate Policies, and regulations. This includes managing, monitoring, and ensuring compliance of the Change Control Program, as well as...
-
Corporate Attorney
3 weeks ago
Miami, Florida, United States GF IMMIGRATION LAW, PA Full timeJob DetailsWe are seeking a highly skilled Corporate Attorney - Compliance Expert to join our team at GF IMMIGRATION LAW, PA. As the primary legal advisor for the company, you will oversee all legal matters, ensure compliance with laws and regulations, and provide strategic guidance to senior management.The ideal candidate will have a strong background in...
-
Compliance Officer
4 weeks ago
Miami, Florida, United States Northeastern Tribal Health System Full timeJob Title: Compliance Officer - Regulatory ExpertAbout the Role:We are seeking a highly skilled Compliance Officer to join our team at Northeastern Tribal Health System. As a Compliance Officer, you will play a vital role in overseeing our compliance program, ensuring that we maintain the highest standards of ethics and integrity.Key Responsibilities:Develop...
-
Cloud Security and Compliance Expert
4 weeks ago
Miami, Florida, United States Cutting Edge Recruiting Solutions Full timeJob Summary:Cut ting Edge Recruiting Solutions is seeking an experienced Cloud Security and Compliance Expert to join our team. In this role, you will be responsible for ensuring the security and compliance of our clients' Microsoft 365 environments. Your expertise in cloud security and compliance will be critical in protecting our clients' digital estates...
-
Contract and Compliance Specialist
3 weeks ago
Miami, Florida, United States Paysend Group Full timeKey ResponsibilitiesProvide legal counsel on projects and initiatives across the USA and LatAm regions, including product development and regulatory compliance.Analyze federal and state laws, as well as regulations affecting the fintech industry, to support strategic business decisions.Draft, review, and negotiate various agreements, including vendor,...
-
Regulatory Compliance Expert
4 weeks ago
Miami, Florida, United States Jeeter Full timeKey Responsibilities:Regulatory Compliance:Ensure all cannabis inventory processes comply with state and federal regulations regarding inventory management and reporting.Stay updated on cannabis regulations and adjust inventory and data practices to maintain compliance with legal standards.Conduct periodic audits of data and inventory records to ensure...
-
Financial Compliance Expert
6 hours ago
Miami, Florida, United States Diversified Porffolio Inc Full timeKey ResponsibilitiesFinancial Record Management: Manage and maintain accurate financial records, including ledgers, invoices, receipts, and payments.Tax Compliance: Ensure compliance with local, state, and federal tax regulations, staying updated with changes in tax laws and accounting standards.Financial Reporting: Generate financial reports, including...
-
Safety and Compliance Expert
3 weeks ago
Miami, Florida, United States Vets Hired Full timeJob Description:Vets Hired is seeking a skilled Workplace Safety Specialist to join our team. The successful candidate will have a strong background in occupational health and safety and be able to develop, implement, and ensure compliance with all safety policies and procedures.About the Role:The Workplace Safety Specialist will be responsible for...
-
Financial Institution Compliance Expert
3 weeks ago
Miami, Florida, United States Educational Federal Credit Union Full timeJob SummaryWe are seeking a skilled Regulatory Compliance Analyst to join our team at the Educational Federal Credit Union. This critical role ensures compliance with all applicable regulatory requirements and involves collaboration with various departments and business units.Key ResponsibilitiesConduct regular compliance assessments and quality control...
-
Trade Compliance Expert
13 hours ago
Miami, Florida, United States Prime Air Cargo Inc Full timeKey ResponsibilitiesThe Export Logistics Coordinator will be responsible for the following key areas:Coordinating and managing all aspects of export logistics, including scheduling, documentation, and customs compliance.Communicating with carriers, overseas agents, and customers via telephone and email.Taking booking requests and export customer service...
-
Regulatory Compliance Specialist
3 weeks ago
Miami, Florida, United States Educational Federal Credit Union Full timeAbout Our TeamWe are committed to providing our members with quality financial services since 1935. As an employer, we strive to offer challenging career opportunities, excellent benefits, and a friendly work environment. Confidentiality is paramount in this position.Estimated Salary: $65,000 - $85,000 per yearKey Job Duties:Conduct thorough compliance...
-
Compliance Specialist Lead
1 day ago
Miami, Florida, United States Ferrer Pulmonary Institute Full timeFerrer Pulmonary Institute OverviewAt the Ferrer Pulmonary Institute, we are committed to delivering high-quality products and services that meet the needs of our customers. Our team of experts works tirelessly to ensure that our products comply with all relevant regulations and standards.Job DescriptionWe are seeking a skilled Compliance Affairs Specialist...
-
Regulatory Compliance Officer
3 weeks ago
Miami, Florida, United States Educational Federal Credit Union Full timeJob OverviewThe Regulatory Compliance Analyst role at Educational Federal Credit Union plays a pivotal part in ensuring adherence to regulatory requirements.This position is responsible for coordinating compliance initiatives, tracking management centrally, and serving as a liaison between various business units when updates are required.Key...
-
Client Service Expert
1 day ago
Miami, Florida, United States Nobel Marketing Full timeYour RoleYou will work directly with customers to promote our clients' brand, products, and services. Explain product features and benefits to customers and confidently answer any inquiries. Report customer feedback to Senior Management and clients, providing feedback on areas of improvement.Analyze client acquisition metrics and KPIs to maximize sales and...
-
Compliance and Planning Expert
1 day ago
Miami Springs, Florida, United States CyberCoders Full timeKey ResponsibilitiesPrepare and review complex tax returns for individuals, partnerships, and corporations.Provide strategic tax planning and advice to clients on various tax matters, including international taxation.Assist in the development and implementation of tax strategies to minimize tax liabilities.Maintain up-to-date knowledge of tax laws and...
-
Financial Compliance Specialist
4 weeks ago
Miami, Florida, United States Carrie Rikon & Associates, LLC. Full timeWe are seeking an exceptional Financial Compliance Specialist to join our dynamic Audit division at Carrie Rikon & Associates, LLC. in Miami.This role is focused on ensuring compliance with regulatory requirements, identifying areas for improvement, and implementing effective financial controls.About Us:Carrie Rikon & Associates, LLC. is a full-service...