Claims Manager, Operation Gov. Pharma, Managed Services

Kpmg Chicago , IL 60602

Posted 7 days ago

Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering real results for our clients. It's also enabled by our culture, which encourages individual development, embraces an inclusive environment, rewards innovative excellence and supports our communities. With qualities like those, it's no wonder we're consistently ranked among the best companies to work for by Fortune Magazine, Consulting Magazine, Working Mother Magazine, Diversity Inc. and others. If you're as passionate about your future as we are, join our team.

KPMG is currently seeking a Claims Manager to join our Business Development Organization.

Responsibilities:

  • Act as a client lead on KPMG's Government Programs Managed Services service, providing day to day oversight of the client relationship, and oversight of the quarterly operations related to Government Programs government claims operations activities; Plan and execute on client engagements focusing on business processes and risk mitigation in areas such as service, delivery and operations, third party management, data management, application management and service continuity management amongst others

  • Work directly with the client and engagement team to provide ongoing claims deliverables each cycle, review Policies and Procedures, reporting requirements for the client and identify risk and controls gaps and provide sustainable solutions for executing risk mitigation project in accordance with the engagement and engagement team; Manage day to day processes and ensure documents as part of the ongoing process are audit ready and in accordance with the engagement

  • Stay current with industry standards and regulatory requirements around the Government Pricing area for Healthcare Life Sciences and the firm; apply understanding of Government Programs Price reporting, Medicaid Claims reporting, Federal Supply Schedule and general Pharmaceutical industry experience

  • Accountable as the liaison for KPMG with various clients on a day to day basis and oversee work completed by Associates or others, as needed; Oversee dispute resolution and recalculation processing and acting backup for Calculation Manager for various clients, as needed and prepare and delivers monthly and quarterly results and deliverables to the client

  • Confirm the accuracy of the results based on the analysis associated with the customer data, methodology, systems and data reconciliations

  • Ensure maintenance of system data (i.e. Customer master, product master) are up to date with various government reporting systems and client intake files

Qualifications:

  • A minimum of five years of experience in one of the following areas for pharmaceutical products within either the pharmaceutical industry or a consulting firm: Government Price Reporting (including policy and SOP development), Government Pricing Methodologies for both branded and generic pharmaceutical products, Government Medicaid and Tricare Claims processing, Federal Supply Schedule negotiation and maintenance; strong working knowledge of multiple areas a plus

  • Bachelor's degree in an appropriate field from an accredited college/university

  • Ability to manage and oversee various projects and tasks with tight deadlines

  • Strong attention to detail and high level of proficiency in Microsoft programs

  • Travel may be up to 50-75% working with various clients and internal stakeholders

  • Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future

KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm's compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.


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Claims Manager, Operation Gov. Pharma, Managed Services

Kpmg