Gifthealth

• Leads, mentors, and manages a team of product managers while setting the standard for product craft and decision-making • Owns and drives product and platform strategy for Digital Pharmacy Systems (DPS) and Gastro (GAS) offerings • Translates company and product strategy into roadmap priorities and measurable product outcomes • Prioritizes initiatives and makes clear trade-off decisions aligned with business goals and technical capacity • Partners cross-functionally with engineering, design, operations, and business stakeholders to deliver scalable solutions • Removes blockers and ensures rapid execution while maintaining product quality and reliability • Promotes AI-native product development practices in discovery, tooling, and delivery

• Build, maintain, and update CallMiner scorecards based on business needs, quality standards, and operational goals. • Partner with leadership, QA, training, and operations teams to understand reporting needs and build meaningful dashboards and reports. • Create and manage CallMiner searches, categories, alerts, and reporting structures. • Monitor scorecard performance and recommend adjustments to improve accuracy and usability. • Pull and analyze call data to identify trends, risks, coaching opportunities, and process gaps. • Support ongoing call quality initiatives by ensuring reporting and scorecards align with current business expectations. • Assist with testing and validating new scorecards, reports, and system updates. • Provide support and guidance to internal users on CallMiner functionality, reporting, and best practices. • Maintain documentation related to scorecard logic, reporting processes, platform updates, and user guidance. • Work cross-functionally to ensure CallMiner insights are being used to improve customer experience, compliance, and team performance.

• Build, Train, and Lead the Field Sales Team (25%) • Define Field Strategy (15%) • Forecast and Deliver on Growth Targets (15%) • Define and Manage to KPIs (15%) • Own Full Sales Pipeline from Targeting to Close (15%) • Cross-Functional Partnership (15%)

• Designing and building agentic AI systems including LLM orchestration, RAG pipelines, and multi-agent frameworks • Leading, mentoring, and growing AI Engineers • Conducting one-on-one meetings, performance reviews, and identifying career development opportunities • Establishing engineering practices, coding standards, and technical processes for AI systems

• Perform end-to-end reconciliation of third party pharmacy claims across Medicare Part B and D, Medicaid, commercial insurers, and PBMs • Analyze claim denials and rejections by payer, denial code, and drug category • Monitor actual reimbursement against expected contract rates for each payer • Manage outstanding AR aging by payer, prioritizing high-dollar claims • Serve as a point of contact for payer portals, provider relations representatives, and clearinghouse inquiries • Ensure all reconciliation activities adhere to CMS guidelines, HIPAA requirements, and internal audit protocols • Work closely with pharmacy operations, finance, and technology teams to surface workflow inefficiencies

• Own primary pharma manufacturer client relationships, serving as the main point of contact for strategic alignment, communication, and long-term trust-building across all assigned programs • Lead escalation management by triaging, owning, and resolving client issues; engage Product, Engineering, or Operations as needed and participate directly on client calls rather than relaying status • Surface client needs to the Product Manager and attend client scoping sessions to ensure the prioritization process reflects client context; contribute to solution design in partnership with Product • Align with clients on scope, strategic priorities, and program performance; set and manage client expectations across all active programs to ensure consistent delivery against commitments • Lead and develop direct reports, including a Client Success Manager focused on account health and program monitoring and an Operations Manager focused on day-to-day program operations; team size scales with program volume • Collaborate closely with the Project Manager on delivery coordination and cost transparency; partner with Engineering, Pharmacy Dispensing Operations, Patient Experience, and Data teams to ensure seamless program execution

• Lead the design and development of learning programs • Translate business processes, SOPs, and regulatory requirements into effective learning experiences across multiple formats • Analyze current training programs for effectiveness and identify areas for improvement • Develop assessments and evaluations to measure training effectiveness • Revise materials to reflect policy, regulatory, and workflow changes • Manage project timelines, resources, and stakeholder expectations to ensure timely and successful delivery of learning initiatives • Create instructor and participant guides, training resources, and visual aids

• Analyze the full patient journey across queues: prescription intake, processing workflows, communication touchpoints, and fulfillment outcomes. • Identify friction points, trends, and opportunities that impact patient satisfaction, speed to therapy, and medication adherence. • Build dashboards and reporting in Looker that illuminate patient-level and operational KPIs. • Translate complex data into clear, actionable narratives for leaders across multiple departments. • Forecast patient demand, workflow volume, staffing needs, and operational load using statistical modeling. • Partner with operations, engineering, and product teams to identify data gaps and improve reporting.

• Answer inbound calls from patients, providers, and pharmacy partners with professionalism and empathy. • Handle high-volume call center operations while maintaining service quality and accuracy. • Take verbal prescriptions from providers and ensure proper documentation in accordance with state regulations. • Transfer calls related to clinical questions or counseling needs to remote pharmacists. • Accurately process prescriptions and input patient data into the pharmacy system. • Make outbound calls to prescribers for clarifications, refill requests, and medication verifications. • Troubleshoot patient issues related to orders, insurance, or delivery, escalating when needed. • Maintain accurate and confidential patient records, including address, allergies, and prescription history. • Respond to emails and chat inquiries as needed, ensuring a prompt and thorough resolution. • Collaborate closely with internal pharmacy operations, the pharmacist team, and external fulfillment partners. • Adhere to all pharmacy laws, regulations, and compliance requirements. • Contribute to continuous improvement by identifying call trends and suggesting workflow optimizations. • Attend training sessions to stay current on pharmacy practices and customer service techniques.

Title: Reimbursement Analyst Location: Fully Remote United States At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives. Position Summary A Reimbursement Analyst is responsible for being the primary point of contact in assisting patients or healthcare providers in obtaining access to therapy for the reimbursement hub program to which they are assigned. Primary activities may include researching and analyzing moderate to complex reimbursement policies, billing, benefit investigations, prior authorization, appeals and patient assistance support programs. Responsibilities, may include interactions with client contacts as well as handling of escalated cases/issues. Key Responsibilities - Assist patients and healthcare providers with moderate to complex billing and coding, insurance benefit investigations, prior authorization, appeals and patient assistance support programs inquiries. - May include acting as regional contact for senior level client contacts. - Manage patient cases and interact with external contacts like payers and other stakeholders. - Assist with coordination of relevant tasks/activities between Gifthealth and the client. - Review and resolve denied or underpaid insurance claims. - Identify and assess patient specific insurance coverage options for client specific products. - Reverify patient benefits at predetermined time frames - Document all activities in program database within required timelines. - Research payer medical policy - Monitor and update payer prior authorization requirements and coverage policies for specified client program. - Prepare and/or assist with preparation of reports as requested, including adverse event and product complaint reports. - Review and process documentation to determine patient specific eligibility for client patient support program(s), as appropriate. - Complete quality monitoring and quality assurance activities, as assigned. - Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 5%. Qualifications - Minimum four years recent healthcare experience (2 years’ direct industry preferred). - Exhibit proficiency in Microsoft Office products - Excellent customer service skills (call center experience preferred). - Advanced problem solving, research and analytical skills. - Advanced communication skills, both written and verbal. - Attention to detail, data entry accuracy required. - Ability to multi-task and manage time independently. - Client interaction experience preferred. - Advanced knowledge of medical insurance (public and commercial), billing and - coding and associated terminology. Work Environment - Location: Remote - Schedule: Full-time - May require availability or flexibility for escalations. - Regular meetings with teams, departments, or leadership to ensure alignment. Key Essential Functions - Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday. - Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift. - Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling. - Ability to view and read information on a computer screen for prolonged periods. - Ability to communicate clearly and professionally via phone, email, and internal systems. - Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy. - Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards. - Ability to adapt to changing priorities, workflows, and processes in a fast-paced environment. - Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require. Employment Classification Status: Full-time FLSA: Non-Exempt Equal Employment Opportunity (EEO) Statement Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status. Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time. Salary Description $24.81 - $29.18