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