Director, Business Services (Medicaid Operations)

Responsibilities:

• Own and develop best-in-class delivery processes and outputs that provide clients with a positive experience and demonstrate the value of the service.
• Act as a driver of efficiency and a leader of change, continually improving business services processes and programs and championing best practices across the group.
• Direct the review and approval of Medicaid rebate deliverables to clients, ensuring quality, accuracy, compliance with government and contractual requirements, and adherence to SLAs.
• Responsible for review and approval of the setup and maintenance of customer contracts and data management within Model N systems.
• Comply with all SOC controls and internal processes and procedures.

Medicaid Subject Matter Expertise & Regulatory Leadership

• Serve as the subject matter expert in Medicaid processing and contracting, setting best practices and sharing thought leadership with clients, direct reports, peer groups, and senior leadership.
• Understand the impact of regulatory changes, proactively identify the process and system changes required to support them, and educate internal and external stakeholders on those impacts.
• Drive rebate savings through a deep understanding of Medicaid claims-level detail validations and by partnering with states to resolve disputes.

Team Leadership & People Development

• Lead, coach, and develop a high-performing Medicaid operations team, fostering a culture of accountability, collaboration, continuous improvement, and client service excellence.
• Build team capability through clear goals, ongoing feedback, development planning, and effective performance management that supports both individual growth and business priorities.
• Create an inclusive, globally connected team environment that enables colleagues across regions, functions, and time zones to work effectively together and deliver consistent results.
• Provide leadership through change, helping the team adapt to evolving client needs, regulatory requirements, technologies, and operational priorities.

Client Relationship Management

• Own and grow strategic client relationships, serving as the senior point of escalation and developing strong partnerships with clients and internal stakeholders.
• Respond to customer and client inquiries regarding processing status, reconciliation questions, data discrepancies, and payment status.

Cross-Functional Partnership & Innovation

• Collaborate with GP Pricing and GTN teams, participating in cross-functional meetings and providing insights and information as required.
• Work directly with product teams to drive system enhancements and efficiency, including adoption of AI and automation, ensuring requirements are defined and tested and that change management is in place to embed new capabilities into business processes.

Qualifications:

• Bachelor’s degree in accounting, Finance, Business, or related field
• 10+ years of experience working in the pharmaceutical industry with Medicaid agreements, including experience leading teams and managing client relationships, is required.
• Proven people leadership experience, with the ability to build, coach, and develop high-performing teams, set clear expectations, and foster a culture of accountability, collaboration, and continuous growth.
• Demonstrated ability to lead through change and serve as a change agent, driving process improvement, operational transformation, and adoption of new ways of working across teams and stakeholders.
• Experience working with Medicaid rebate systems; recognized subject matter expertise in Medicaid rebates, with the ability to set and champion best practices.
• Experience working in mandated deadline environment; effective management of multiple client assignments; ability to prioritize.
• Must be able to comprehend and/or learn complex government compliance requirements and retain, build upon, and apply this knowledge daily.
• High accuracy rate and attention to detail along with high degree of analytical skills; ability to produce client-ready deliverables to a high-level executive/professional client base.
• Able to manage multiple and competing tasks across functional areas is essential.
• Technical ability to understand underlying data structures and deal with large amounts of data.
• Experience achieving and maintaining compliance with all applicable regulatory, legal, and operational rules and procedures and activities are met with “best” industry practices.
• Ability to deliver required periodic results with a high degree of accuracy and minimal management review.
• Demonstrated experience using generative AI tools (e.g., ChatGPT, Copilot, Claude, Gemini) to improve productivity, decision‑making, or problem solving in a professional or personal context.
• Advanced proficiency in Microsoft Office, with strong capabilities in Excel, PowerPoint, and Word to analyze data, develop client-ready materials, and communicate insights effectively.
• 10-20% of travel required