Phil, Inc.

• Own and evolve the strategic roadmap for PHIL’s expansions including specialty pharmaceuticals, controlled substances, biologics, etc., aligning technical capabilities with business priorities. • Benchmark against industry best practices, and build a plan to achieve best in class service offerings based on strategic direction and priorities. • Drive significant improvements in PHIL solutions through optimized processing and judicious use of third party integrations vs internal capabilities. • Develop and champion new platform capabilities to support expanded therapeutic categories and patient therapy management. • Set long-term success metrics and operational KPIs, and ensure the product roadmap is tightly aligned with measurable outcomes. • Lead cross-functional partnership with senior stakeholders across Product, Engineering, Operations, and Commercial teams to define priorities and deliver value. • Lead discovery efforts and user research to identify top opportunities to deliver value, while ruthlessly prioritizing to maintain organizational focus and drive specific outcomes. • Mentor product team members and elevate the overall product team capability through thought leadership, strategic rigor, and operational depth

• Support client engagement and program success – Help develop and execute plans to ensure smooth program launches, tracking key pre-launch milestones and flagging risks early. • Program coordination & client support – Work closely with clients to support day-to-day needs, helping translate client goals into actionable next steps for PHIL. • Performance analysis & reporting – Analyze program performance against key success metrics, build reporting and dashboards, and surface insights that help clients and internal teams understand what's working and what isn't. • Client relationship management – Serve as a trusted day-to-day point of contact for clients, supporting discussions on program performance, goal alignment, and areas for improvement. • Stakeholder collaboration & problem-solving – Partner with internal teams (client success, product, operations) and external client contacts to resolve issues, escalating and diplomatically navigating pushback as needed. • Data quality & process improvement – Help ensure the quality and accessibility of program data through cleansing, modeling, and maintenance, and identify opportunities to improve tooling and processes for greater efficiency.

• AI and Automation Strategy for Quality • Define and own the strategy to scale quality through automation, software-based quality controls, and AI-enabled monitoring, reducing reliance on manual audit headcount. • Build AI-driven monitoring that flags error signals in real time and surfaces risk patterns before they result in operational or patient-facing errors. • Partner with Engineering and Product to embed automated quality checks directly into operational systems so quality is enforced at the point of work, not inspected afterward. • Maintain a forward roadmap for emerging quality capabilities, evaluating new tools and techniques and integrating them into the operating model as they mature. • Shift the quality function from detecting errors after they occur to preventing them upstream through process controls, system design, and early-signal monitoring. • Identify the conditions and process points that produce errors and drive design changes that remove the failure mode rather than catching it later. • Build predictive indicators that allow the organization to intervene before a defect becomes a realized error. • Own an escalation framework with assigned owners, target resolution dates, and defined escalation paths for every cross-functional quality issue. • Drive quality issues to resolution across operational partner teams, holding partner leaders accountable to committed timelines. • Originate and complete cross-functional quality improvement initiatives with documented, measurable outcomes such as error rate reduction or implemented process change. • Engage partner leadership the moment issues are identified rather than allowing them to persist across review cycles. • Maintain a live initiative tracker covering milestones, owners, status, and blockers for all active quality projects. • Deliver staffing models, reporting standardization, and automation roadmaps on committed timelines without requiring repeated direction. • Escalate blockers quickly with a written proposed path forward, and ensure no initiative stalls without timely escalation. • Maintain deep fluency across the core operational workflows the quality function oversees. • Lead structured deep-dives and produce data-supported root cause analyses that identify the issue, the root cause, supporting data, and a specific corrective action. • Independently diagnose error patterns and drivers in executive settings without reliance on prepared summaries. • Produce structured pre-reads and prep materials for executive and business reviews. • Deliver clear, data-driven narratives covering metrics, trends, root cause, actions taken, and open items. • Independently own leadership communication and delivery to senior operational audiences, including the executive team. • Lead and develop the quality team across audit, analysis, and quality engineering functions. • Build reporting infrastructure and quality systems that give leadership real-time visibility into error rates and drivers. • Partner with Engineering and Product to embed quality monitoring and automated controls into operational platforms.

• Own and evolve the strategic roadmap for PHIL’s external integrations including electronic health records, payers and plans, third party providers, etc., linking high-level business strategy to technical requirements and product outcomes. • Benchmark against industry best practices, and build a plan to achieve best-in-class service offerings based on strategic direction and priorities. • Solve complex problems efficiently by driving significant improvements in quality and speed through optimized processing and judicious use of platform capabilities vs internal development. • Develop and champion new platform capabilities to support expanded therapeutic categories and patient therapy management. • Set long-term success metrics and operational KPIs, and ensure the product roadmap is tightly aligned with measurable outcomes. • Act as a venturesome industry leader, identifying and evaluating third-party systems and service providers to keep PHIL at the forefront of the health-tech landscape. • Lead cross-functional partnership with senior stakeholders across Product, Engineering, Operations, and Commercial teams to define priorities and deliver value. • Lead discovery efforts and user research to identify top opportunities to deliver value, and ruthlessly prioritize to maintain organization focus. • Mentor product team members and elevate the overall product team capability through thought leadership, strategic rigor, and operational depth

• Accelerate Client Onboarding: Deeply understand PHIL’s architecture to build a repeatable, highly configurable technical playbook for launching new clients and programs efficiently. • Design Complex Workflows: Implement and manage sophisticated, rule-based workflows to support pharmacy operations, compliance, and patient engagement while minimizing processing errors. • Drive AI Automation: Leverage AI-first development methodologies and build intelligent automations to increase the quality, reliability, and velocity of platform releases. • Architect & Scale Backend Systems: Design and maintain highly reliable, low-latency APIs and microservices using AWS native tools (ECS/EKS, Lambda, RDS, DynamoDB). • Own System Reliability: Write clean, observable code with robust logging and monitoring to ensure fault tolerance and zero downtime in a highly critical healthcare environment. • Cross-Functional Leadership: Collaborate with Product Managers, Data Analysts, and external stakeholders to align technical solutions with business growth objectives. • Technical Anchor: Act as a mentor to junior engineers, promoting a culture of strict architectural discipline, rapid innovation, and technical accountability. • Technical Escalation & Documentation: Document platform architecture to ensure long-term maintainability, and serve as the engineering tier-escalation point for complex client launch issues.

• Define and drive the product strategy and roadmap for Phil’s prescription fulfillment processes and products, including pharmacy and partner operations. • Collaborate with internal stakeholders, such as pharmacy teams, fulfillment partners, and client success teams, to identify and prioritize product requirements. • Expand platform capabilities to support new types of medications and enhance Phil’s overall service offerings. • Continuously iterate on product features and processes to improve operational efficiency and meet key performance metrics. • Participate in user research and process analysis to inform product improvements and future plans. • Set, track, and deliver on metrics-based goals to ensure operational success and deliver measurable outcomes for patients and clients.

• Place outbound calls to insurance carriers and navigate payer phone systems to reach eligibility and benefits representatives • Verify active coverage and obtain detailed benefits information including deductibles, copays, coinsurance, out-of-pocket maximums, prior authorization requirements, and in/out-of-network benefit levels • Accurately document all information obtained during each call, including reference numbers, representative names, and call timestamps • Interpret call outcomes and apply decision criteria to move each case to the correct next step in the workflow (e.g., eligible for services, requires prior auth, inactive/terminated coverage, patient financial responsibility assessment, denial routing) • Identify discrepancies between payer-reported benefits and information on file and escalate appropriately • Meet daily productivity and quality standards for call volume and documentation accuracy • Maintain working knowledge of common insurance terminology, plan types (HMO, PPO, EPO, HDHP), and payer-specific requirements

• Assist in the design, development, testing, and deployment of AI/ML models and applications • Collaborate with Engineering, IT, and business stakeholders to translate business needs into technical solutions • Build and optimize data pipelines and inference workflows • Develop prototypes and AI-powered applications within cloud environments such as AWS • Work with both structured and unstructured datasets, including text, APIs, and image-based data • Experiment with large language models (LLMs), prompt engineering techniques, and AI APIs • Document code, experiments, and technical findings for team collaboration and knowledge sharing • Participate in code reviews, sprint planning, and technical discussions with the Engineering team • Present project work and findings to technical and business stakeholders • Support additional projects and initiatives as needed across the department

• Conduct thorough research on order and ticket history to recommend the best resolution that aligns with department guidelines. • Ensure all Service Level Agreements (SLAs) are met. • Contact relevant stakeholders to resolve issues that require cross functional collaboration that may impact a successful patient experience. • Build strong internal and external rapport, maintaining positive customer and partner relationships. • Review and respond to internal escalation requests in a timely and accurate manner. • Proactively initiate, troubleshoot, and resolve PAs and appeals via vendor portals; analyze determination trends to provide valuable insights for patient education. • Serve as the expert liaison between prescribers, insurance payers, and partner pharmacies, translating technical hurdles into actionable solutions that ensure patient access to therapy. • Partner closely with Customer Support to provide clear, jargon-free updates and documentation in our operating systems, ensuring the team has the patient-ready insights needed to support the patient’s journey. • Efficiently navigate multiple software systems and vendor portals with a self-starter mindset, maintaining the flexibility to prioritize tasks based on clinical urgency. • Investigates complex claim rejections and partners with payers and pharmacies to diagnose root causes and establish and execute a clear resolution pathway that is in accordance with regulatory requirements and manufacturer business rules. • Act as the primary technical "fixer" for orders falling outside standard workflows, resolving obstacles such as insurance exceptions, pharmacy rejections, failed transfers, and state-specific shipping regulations.

• Troubleshooting electronic, faxed, and verbal prescriptions via routing to appropriate channels into pharmacy systems • Review and update patient insurance using payer portals and phone resources • Determining appropriate situations for a prior authorization (PAs) need via payer-specific tools; troubleshoot denials and escalations • Utilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers • Navigate operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems effectively • Follow reroute protocols for specific tags including: non-contracted pharmacies, state shipping changes, PP send-backs, transfer not received, and more • Proactively document process notes with clear routing details, claim updates, and actions taken • Communicate with partner pharmacies, provider offices, and insurance carriers to resolve issues or clarify documentation • Collaborate with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock issues, or policy refusals • Maintain productivity in the Reroute queue even during extended call hold times (e.g., multitask during insurance calls) • Ensure all patient, prescriber, and partner communications are clear, professional, and aligned with Phil’s standards of care