Formulary Operations Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Configure, update, and manage both custom and standard formularies within the claims adjudication system.

• Ensure the precision and consistency of formulary builds with client objectives, clinical strategies, and regulatory standards.

• Diagnose adjudication issues and discrepancies; perform in-depth analyses to rectify defects and anomalies.

• Engage in client implementations by collecting and documenting formulary requirements.

• Act as a subject matter expert in clinical capabilities.

• Collaborate with internal teams to facilitate the seamless integration of formulary solutions.

• Conduct audits to verify the accuracy of formulary configurations.

• Oversee claim processing to identify and proactively correct potential issues.

• Aid in analyzing and presenting data related to formulary performance or disruptions.

• Extract, organize, and compile data and reports to support client meetings and formulary strategy presentations.

• Assist with client interactions as necessary, including addressing formulary-related inquiries and participating in training sessions.

• Work closely with clinical partners to ensure that clinical directives are accurately reflected in system configurations.

• Contribute to the development and documentation of internal workflows, best practices, and training materials.

• Lead or assist in special initiatives such as process optimization, disruption analyses, or platform enhancements.

• Suggest and implement enhancements to improve the accuracy, efficiency, and scalability of formulary operations.

⛳️ Requirements

• Bachelor’s degree or 1 year of equivalent experience in healthcare (PBM).

• Over 1 year of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics.

• Proven expertise in configuring and maintaining formulary data within claims systems.

• Strong working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations.

• Exceptional problem-solving abilities with the capability to analyze data and convert findings into actionable solutions.

• Detail-oriented, capable of managing multiple priorities and meeting deadlines.

• Outstanding written and verbal communication skills — clear and concise for both internal and client-facing audiences.

• Excellent organizational and time management abilities.

• Capacity to lead projects and ensure completion.

• Proficiency in Microsoft Excel and advanced knowledge of the Microsoft Office Suite for creating complex documents and data analysis.

• Self-motivated with a proactive approach and a high degree of accountability.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment that values collaboration and innovation.