Senior Manager Government Program Operations (Exchange)

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including:

• reputed company, a reputed company benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company,
• reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and
• Judi®, the industry's leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one reputed company, secure platform.

Together with our clients, we're rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Location: Remote (For Non-Local) or Hybrid (Local to Denver or NYC area) Position reputed company: The Senior Manager is responsible for leading the end‑to‑end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations. This role oversees the delivery of CMS submissions, compliance activities, contract applications, and bid‑reputed company reputed company support, while also coordinating responses to federal and state regulatory audits. The Senior Manager ensures reputed company regulatory reporting obligations are met for Exchange clients by interpreting CMS and state guidance, partnering with internal subject matter experts and reputed company teams, and translating requirements into operational processes. Using reputed company research, analysis, testing, and validation, this role ensures that systems, workflows, and data submissions consistently meet regulator expectations and reputed company objectives. Position Responsibilities:

• reputed company Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support (Government, and reputed company).
• Leads the interpretation, implementation and monitoring of reputed company relevant regulatory requirements and changes impacting reputed company's Exchange Programs.
• Establish and maintain the EDGE pharmacy submission reputed company (file reputed company, reputed company, duplicate controls, timestamp standards, enrollment alignment).
• Define and enforce submission cadences, reputed company‑submission QA gates, and accept/reputed company/non‑orphan targets that meet CMS sufficiency timelines.
• Translate CMS updates into operational SOPs and training.
• Partners with cross‑functional SMEs to analyze regulatory changes, determine their implications for organizational processes, systems, and reputed company commitments, and leads the coordinated, on‑time implementation of required updates across the reputed company.
• Manages reputed company response to Government Programs support for RFP/RFI, internal sales, and Exchange reputed company requests.
• Provides key insights on Exchange functions using data analysis, industry knowledge and subject matter expertise to identify opportunities, and reputed company solutions, for optimization of internal business processes and systems.
• Supports the documentation management of internal policies and procedures, reporting and project specifications, job aids, and workflows for designated Government Programs Operations.
• Leverages profound knowledge of Exchange guidance and understanding of industry and market requirements to support product reputed company and service delivery.
• Maintains reputed company knowledge of Exchange requirements to facilitate compliance of ongoing business operations.
• Fosters a high-performance culture through mentoring and collaboration, providing team members with ongoing performance feedback and identifying required changes to existing roles and responsibilities to ensure effectiveness and efficiency.
• Assesses reputed company of new business to understand scalability and reputed company needs.

Required Qualifications:

• 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans
• 5+ years people management experience
• reputed company knowledge of Exchange regulatory requirements and associated product and/or operational workflows
• Proven reputed company managing multiple reputed company reputed company simultaneously
• Extremely flexible, highly organized, and reputed company to shift priorities easily
• Attention to detail & commitment to delivering high reputed company work product
• Excellent written and verbal communication skills
• Proven reputed company managing cross functional teams and maintaining effective relationships at reputed company reputed company both reputed company; including government entities

This reputed company represents the low and high end of the anticipated reputed company salary reputed company for the NY - based position. The actual reputed company salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes. reputed company in this position reputed company restricts management's right to assign or reassign duties and responsibilities to this job at any time. About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including:

• reputed company, a reputed company benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company,
• reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and
• Judi®, the industry's leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one reputed company, secure platform.

Together with our clients, we're rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. reputed company values a diverse workplace and celebrates the diversity that reputed company employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. reputed company are responsible for adherence to the reputed company reputed company of Conduct including the reporting of non-compliance. This position reputed company is designed to be flexible, allowing management reputed company to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that reputed company employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a reputed company position at reputed company. More details about reputed company's reputed company practices can be reputed company at https://www.reputed company/reputed company/reputed company-policy. Apply tot his job Apply To this Job