Manager, Healthcare Data Quality and Audit

Imagine360 is seeking a Manager, Healthcare Data Quality and Audit to join the team! The Manager, Healthcare Data Quality and Audit is responsible for leading healthcare and pharmacy data QA, data quality oversight, reconciliation, accuracy, and integrity of inbound and outbound healthcare data files, including 834, 837, 270, 271, 276 and 277 transactions, pharmacy claims, accumulator, and partner interface data across Imagine360 systems and Pharmacy Benefit Manager (PBM) partners. This role provides leadership for healthcare data monitoring, audit controls, discrepancy resolution, vendor accountability, and continuous improvement while managing and coaching a team of 10+ onshore and offshore resources. The Manager will oversee healthcare data integrity processes, inbound and outbound EDI data validation, pharmacy claims quality controls, and timely identification and resolution of data quality issues. This role partners closely with technology teams, claims operations, implementation teams, PBM vendors and business stakeholders to establish scalable controls, reporting standards, production monitoring practices, and operational processes that support accurate data transmission, benefit tracking, claims adjudication integrity, downstream system accuracy, and effective team performance across distributed teams.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Manage, lead, coach, and develop a team of 10+ onshore and offshore resources supporting Healthcare data QA, pharmacy data QA, reconciliation, audit controls, and production monitoring.
• Provide day-to-day leadership, workload prioritization, performance guidance, and accountability to ensure timely, accurate, and high-quality delivery across distributed teams.
• Mentor team members, build technical and operational capabilities, promote knowledge sharing, and support skill development across Healthcare data integrity, QA practices, root cause analysis, and vendor issue management.
• Establish team operating rhythms, quality expectations, escalation protocols, and communication practices to support consistent execution across onshore and offshore resources.
• Provide Strategic leadership oversight for pharmacy data integrity processes, ensuring accurate receipt, validation, reconciliation, and transmission of pharmacy claims, accumulator, eligibility, and healthcare data across internal and external systems.
• Oversee governance and quality assurance of inbound and outbound healthcare transactions, including 834 Eligibility, 837 Claims, 270 Eligibility Inquiry, 271 Eligibility Response, and 276 /277 Claim Status files, ensuring data accuracy, completeness, compliance, and operational readiness.
• Lead investigations of pharmacy data discrepancies, accumulator variances, and PBM reporting issues, partnering with business, technology, and vendor teams to drive resolution and corrective actions.
• Drive resolution of pharmacy claims, accumulator, eligibility, and data transmission issues through collaboration with PBMs, technology teams, claims operations, implementation teams, and business stakeholders.
• Establish scalable controls, monitoring practices, reporting standards, reconciliation procedures, and audit frameworks that improve pharmacy data accuracy, vendor accountability, regulatory compliance, and audit readiness.
• Lead continuous improvement initiatives focused on automation, data quality, reconciliation effectiveness, pharmacy claims operations, PBM integration performance, and operational efficiency.
• Oversee reconciliation and audit processes to ensure pharmacy, claims, eligibility, and EDI transaction data is accurately received, processed, validated, transmitted, and reflected across Imagine360 claim adjudication systems. (Including GBAS, VBA, PBM platforms, and downstream systems.)
• Establish and maintain pharmacy data integrity controls, reconciliation procedures, audit standards, quality checkpoints, reporting templates, and escalation processes.
• Develop quality controls for inbound and outbound file exchanges, including file receipt validation, outbound transmission checks, data completeness, data mapping accuracy, record-level exception review, and audit traceability.
• Ensure compliance with data governance, security, privacy, regulatory, and audit-readiness requirements related to pharmacy data operations.
• Develop and maintain process documentation, SOPs, control logs, evidence repositories, and audit-ready materials to support internal reviews, external audits,