Associate, Patient Assistane Eligibility & Program Integrity Manager

Company: Eli Lilly and Company
Location: Indianapolis
Posted on: April 1, 2026

Job Description:

At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities through philanthropy and volunteerism. We give our best effort to our work, and we put people first. We’re looking for people who are determined to make life better for people around the world. Associate, Patient Assistance Eligibility & Program Integrity ManagerAbout the Role At Lilly, we believe that every patient deserves access to the medicines they need. The Lilly Cares Foundation - a separate charitable organization - brings that belief to life through the Lilly Cares Patient Assistance Program (Lilly Cares PAP), which helps eligible patients access Lilly medications at no cost. Lilly PAP provides operational support to the Lilly Cares Foundation in running this program, and also supports Lilly's donation of medicines to other charitable organizations. As the Eligibility Verification & Program Integrity Manager, you'l1 be at the heart of that mission. This role primarily supports Lilly PAP's operational support of Lilly Cares. We're looking for someone to lead the operational processes that verify patient eligibility, based on eligibility criteria established by Lilly Care, protect program integrity, and detect fraud, ensuring Lilly Cares PAP reaches the people it was designed to serve. We're looking for a professional who thrives at the intersection of compliance, analytics, and patient advocacy. In this role, we'll rely on your expertise to safeguard the program and help us continuously improve the experience for patients and their care teams. What We're Looking For We need someone who brings: A deep understanding of the U.S. healthcare insurance landscape, including PBMs, pharmacy benefit optimizer entities, specialty pharmacies, and other third-party benefit programs Demonstrated experience in fraud prevention, detection, or compliance monitoring within healthcare or patient assistance operations The ability to interpret complex insurance documents - including SPDs, EOCs, drug formularies, and insurance verification records A history of leading and directing vendor and contractor teams, aligning them to program requirements and operational standards Strong analytical instincts - translating data and reports into trends, anomalies, and actionable decisions Clear, confident communication skills, both written and verbal, including experience communicating findings and recommendations to leadership What You'll Do Eligibility Verification & Fraud Protection Own and continuously improve the operational support provided to Lilly Cares associated with eligibility verification processes, ensuring patient applications and supporting documentation are evaluated consistently and accurately against program criteria for Lilly Cares PAP (as established by Lilly Cares) Provide consultative leadership and quality oversight of vendor-performed eligibility reviews for Lilly Cares PAP, resolving complex escalated cases with sound judgment and ensuring accuracy, consistency, and compliance of determinations Identify, assess, and escalate emerging fraud risks and trends for Lilly Cares PAP -including those involving PBMs, specialty pharmacies, benefit optimizer organizations, and non-traditional benefit structures Strengthen the Fraud Protection and Prevention Framework as part of the operational support provided to Lilly Cares by monitoring trends, tracking suspected entities, and recommending updates to detection criteria and operational rules Program Monitoring & Compliance Drive execution quality of the operational support provided to Lilly Cares related to PAP monitoring plans in accordance with SOPs, ensuring vendor outputs meet standards for completeness, accuracy, and timeliness Review and approve monitoring documentation - including quarterly summaries, tools, and findings reports - and translate insights into actionable recommendations for leadership Leverage vendor data and analytics to surface patterns, flag discrepancies, and proactively address program integrity risks for Lilly Cares PAP Ensure compliance with privacy, legal, and regulatory requirements related to patient data - including data inventory, retention, and deletion practices - as part of the operational support provided to Lilly Cares Represent the operational support provided to Lilly Cares in routine eligibility and electronic benefits verification (EBV) governance forums, managing confidential information related to suspected or confirmed fraud with discretion Program Enhancements & Continuous Improvement Coordinate eligibility, monitoring, and fraud-related initiatives for Lilly Cares across PAP project managers and vendor teams - keeping timelines, deliverables, and dependencies on track Champion tools, automation, and process improvements that enhance verification accuracy, monitoring efficiency, and the overall experience for patients and their healthcare providers Keep Lilly Cares PAP application materials, SOPs related to the operational support provided to Lilly Cares, and program documentation current as requirements evolve Partner with Legal, Tax, Privacy, Data & Analytics, and PAP Operations to implement enhancements, compliance updates, and risk-mitigation strategies for Lilly Cares Vendor Oversight & Direction Set clear direction and governance for vendor and contractor teams supporting Lilly Cares in performing eligibility and monitoring activities, ensuring adherence to SOPs, business (operational) rules, and program standards Serve as the primary operational point of contact for vendor eligibility teams supporting Lilly Cares, communicating eligibility criteria updates (as established by Lilly Cares), process changes, and program expectations Collaborate with vendor program management supporting Lilly Cares on SOP revisions, operational readiness, and change implementation Basic Qualifications Bachelor's degree in healthcare administration, public health, business administration, health sciences, or a related field 5 years in U.S. healthcare benefit verification, patient assistance program operations, or specialty medication access Qualified applicants must be authorized to work in the United States on a full-time basis. Lilly will not provide support for or sponsor work authorization or visas for this role, including but not limited to F-1 CPT, F-1 OPT, F-1 STEM OPT, J-1, H-lB, TN, 0-1, E-3, H-lBl, orL-1 Preferred Qualifications Advanced degree or clinical credential (e.g., Pharm.D., RN, MBA) Familiarity with the U.S. payer environment - reimbursement structures, formulary management, and population-based healthcare decision-making as it relates to patient assistance Hands-on experience with electronic benefits verification tools (e.g., SureScripts, EBV platforms), insurance documentation review, and eligibility appeals Experience scoping monitoring tools, automation, and reporting requirements for PAP programs Strong organizational instincts with the ability to balance multiple concurrent workstreams across cross-functional teams Experience with Lilly internal approval processes (e.g., Veeva, Privacy) is a plus A compliance-first outlook and a genuine commitment to patient access Why Join Us We're on a mission to connect patients with life-changing medications - and this role is central to that work We operate at the forefront of healthcare access, fraud prevention, and program integrity We collaborate across a diverse, cross-functional team including Legal, Tax, Privacy, and Analytics We invest in building high-performing teams and vendor ecosystems We're a purposeful organization that puts patients first - and we want you to grow with us Other Information Travel: Limited U.S. travel to vendors and industry conferences Lilly is dedicated to helping individuals with disabilities to actively engage in the workforce, ensuring equal opportunities when vying for positions. If you require accommodation to submit a resume for a position at Lilly, please complete the accommodation request form ( https://careers.lilly.com/us/en/workplace-accommodation ) for further assistance. Please note this is for individuals to request an accommodation as part of the application process and any other correspondence will not receive a response. Lilly is proud to be an EEO Employer and does not discriminate on the basis of age, race, color, religion, gender identity, sex, gender expression, sexual orientation, genetic information, ancestry, national origin, protected veteran status, disability, or any other legally protected status. Our employee resource groups (ERGs) offer strong support networks for their members and are open to all employees. Our current groups include: Africa, Middle East, Central Asia Network, Black Employees at Lilly, Chinese Culture Network, Japanese International Leadership Network (JILN), Lilly India Network, Organization of Latinx at Lilly (OLA), PRIDE (LGBTQ Allies), Veterans Leadership Network (VLN), Women’s Initiative for Leading at Lilly (WILL), enAble (for people with disabilities). Learn more about all of our groups. Actual compensation will depend on a candidate’s education, experience, skills, and geographic location. The anticipated wage for this position is $58,500 - $137,500 Full-time equivalent employees also will be eligible for a company bonus (depending, in part, on company and individual performance). In addition, Lilly offers a comprehensive benefit program to eligible employees, including eligibility to participate in a company-sponsored 401(k); pension; vacation benefits; eligibility for medical, dental, vision and prescription drug benefits; flexible benefits (e.g., healthcare and/or dependent day care flexible spending accounts); life insurance and death benefits; certain time off and leave of absence benefits; and well-being benefits (e.g., employee assistance program, fitness benefits, and employee clubs and activities).Lilly reserves the right to amend, modify, or terminate its compensation and benefit programs in its sole discretion and Lilly’s compensation practices and guidelines will apply regarding the details of any promotion or transfer of Lilly employees. WeAreLilly

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