Operations Planning Specialist (PDP Oversight & Monitoring)

Location: Remote within the United States; candidates must reside in and be authorized to work in a state where HCSC is approved to employ remote workers. Applicants residing in Alaska, California, Hawaii, or New York are not eligible. The posting also lists Nashville, Tennessee.

Base pay: $47,500–$86,000 annually, with eligibility for an annual incentive bonus.

Company

hirify.global is a purpose-driven healthcare organization offering employee development programs and benefits.

What you will do

• Monitor daily Prescription Drug Plan enrollment and premium billing operations with vendors, internal teams, and external partners.
• Review CMS requirements and interpret their impact on operational processes and compliance.
• Track operational metrics, critical volumes, inventories, service levels, and potential issues.
• Conduct weekly monitoring, sampling, evidence tracking, corrective-action reviews, and leadership reporting.
• Support internal, external, and CMS audits by reviewing universes, samples, and supporting documentation.
• Identify trends and process gaps, coordinate remediation, and support readiness activities and vendor policy reviews.

Requirements

• Bachelor’s degree or equivalent experience.
• 3–4 years of experience in Medicare Part D or Part C, government programs, eligibility, premium billing, or healthcare operations.
• Proficiency with Microsoft Word, Excel, Outlook, and PowerPoint.
• Strong analytical, problem-solving, organizational, written, and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced, heavily matrixed environment.
• Must reside in and be authorized to work in an HCSC-approved US state; Alaska, California, Hawaii, and New York are excluded.

Nice to have

• Advanced Excel, report writing, and analysis experience.
• Enrollment, eligibility, process improvement, Medicare Advantage, or Part D experience.

Culture & Benefits

• Remote work opportunity.
• Curated professional development plans and career growth support.
• Health and wellness benefits, 401(k), pension plan, paid time off, paid parental leave, disability insurance, and supplemental life insurance.
• Employee assistance program, paid holidays, tuition reimbursement, and other incentives.
• Employment may be contingent on successful completion of drug screening in accordance with applicable law.