Manager, Healthcare Data Quality and Audit
$100,000–$120,000 year
RemoteUnited States
United StatesRemoteFull Time$100,000–$120,000 yearMedium
Full TimeMedium
Job Summary
Manage and lead a team of 10+ onshore and offshore resources to oversee healthcare and pharmacy data QA, reconciliation, and audit controls for inbound and outbound EDI transactions including 834, 837, 270, 271, 276, and 277 files. Provide day-to-day leadership for workload prioritization, performance guidance, and root cause analysis of pharmacy claims discrepancies, accumulator variances, and PBM reporting issues. Establish scalable controls, monitoring practices, and reporting standards to ensure data accuracy, compliance, and operational readiness across Imagine360 systems and partner interfaces. Monitor production activities for medical and pharmacy claims data, identify processing failures, and drive continuous improvement initiatives focused on automation and efficiency.
Required Qualifications
- Bachelor's degree in business administration, Healthcare Administration, Information Systems, Data Analytics, Finance, or related field
- 10+ years of experience in healthcare claims, pharmacy operations, PBM data QA, healthcare data analysis, auditing, reconciliation, benefit administration, or partner interface support
- Hands-on knowledge of inbound and outbound healthcare data transactions and file exchanges, including 834, 837, 270, 271, 276 and 277 transaction types
- Strong working knowledge of pharmacy claims operations, pharmacy benefit administration, PBM workflows, claims adjudication concepts, accumulator processes, and pharmacy data reconciliation
- Experience working with pharmacy claims data, accumulators, PBM reporting, or healthcare data feeds
- Experience managing and leading 10+ onshore and offshore resources
- Demonstrated leadership and coaching experience, including mentoring team members, setting priorities, managing workload distribution, and developing team performance
- Experience leading data reconciliation, audit controls, issue resolution, and root cause analysis
- Experience coordinating cross-functional work with business, technical, vendor, and operational teams
- Technical proficiency in SQL queries, data analysis, source-to-target validation, data mapping, and record-level reconciliation to support healthcare data quality and root cause analysis
- Experience monitoring SFTP file exchanges, automated data feeds, missing or delayed files, transmission failures, and vendor-related data exchange issues
- Ability to develop and use data quality controls, exception reports, dashboards, and KPI reporting through tools such as Excel, Power BI, SQL, or similar reporting platforms
- Prior experience creating reports, exception tracking, process documentation, or executive-level status updates
- 100% remote
Desired Qualifications
- Advanced degree or certification in healthcare administration, data analytics, process improvement, or related discipline
- Experience working directly with healthcare partner interfaces, PBMs and pharmacy vendors, including data exchange validation, operational issue resolution, and vendor accountability
- Experience supporting healthcare data integrations, EDI transactions, SFTP file feeds, or automated data exchange processes
- Experience with SQL, Power BI, data analytics tools, or reporting platforms
- Familiarity with GBAS, VBA, or similar healthcare claims platforms
- Knowledge of pharmacy benefit administration, accumulator management, and claims adjudication
- Prior experience supervising analysts, leading distributed teams, managing offshore delivery, or overseeing operational workflows across multiple resources
- Experience in process improvement, production monitoring, audit control design, or vendor performance management
- Proven ability to lead, coach, motivate, and develop onshore and offshore teams while maintaining accountability for quality, timeliness, and outcomes
- Strong analytical and problem-solving skills with exceptional attention to detail
- Ability to interpret complex healthcare and pharmacy data to identify trends, anomalies, and root causes
- Strong understanding of data validation, reconciliation methodology, production monitoring, and audit control processes
- Ability to communicate clearly with technical and non-technical stakeholders
- Strong vendor management and escalation skills
- Ability to manage competing priorities in a fast-paced, deadline-driven environment
- Strong documentation, reporting, and process improvement skills
- Ability to build scalable processes and reduce manual operational risk
- Commitment to data accuracy, operational excellence, and continuous improvement
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