PBM Compliance & Reporting Analyst

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

📋 Description

• Assist with federal and state regulatory submissions, including CMS Section 111, CMS RxDC, APCD, DOI filings, DLR reporting, and other state-required pharmacy reports.

• Gather, prepare, validate, and submit data for regulatory applications and renewals.

• Ensure compliance with reporting timelines and maintain filing schedules.

• Keep audit-ready documentation and assist with DOI inquiries, audits, and regulatory assessments.

• Evaluate and confirm eligibility, demographic, accumulator, and claims information.

• Reconcile data between PBM and internal systems, investigate discrepancies, and document exceptions and resolutions.

• Oversee compliance workflows and manage regulatory tracking logs and reporting inventories.

• Collect documentation for both internal and external audits.

• Utilize PBM Source and internal systems for compliance and regulatory reporting activities.

• Create and oversee Jira tickets and workflows; monitor project progress and communicate with stakeholders.

• Manage and address inquiries in the Compliance & Reporting shared mailbox.

• Facilitate submissions through state DOI portals and CMS-related systems.

• Develop and maintain standard operating procedures (SOPs), Confluence documentation, work instructions, and reporting manuals.

• Employ Excel and analytical tools to prepare and validate data files, support dashboards, KPIs, and compliance metrics.

• Analyze reporting patterns and suggest process enhancements.

• Collaborate with Legal Operations, Data Operations, IT, Pharmacy Operations, Eligibility Vendors, and PBM partners.

• Engage professionally with regulatory bodies and external partners as required.

⛳️ Requirements

• 1–3 years of experience in PBM operations, healthcare compliance, regulatory reporting, or data operations.

• Proficient in Excel, including VLOOKUP/XLOOKUP, Pivot Tables, data validation, reconciliation, and cleansing.

• Strong analytical, organizational, and communication abilities.

• Capability to manage several projects and deadlines while maintaining high attention to detail.

• Foundational understanding of CMS reporting requirements, particularly Section 111 and RxDC.

• Familiarity with state DOI reporting procedures.

• Experience in the PBM industry.

• Proficient with Jira, Confluence, or PBM Source.

• Working knowledge of SQL, Python, SAS, or Snowflake.

• Experience in supporting audits or regulatory assessments.

• A bachelor's degree is preferred.

🏝️ Benefits

• Remote-first work environment.

• Option to choose between a HDHP or PPO Medical plan; 100% of the HDHP premium covered for you and eligible family members.

• Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance; 100% of premiums covered for specified coverage.

• Additional buy-up options for Short- and Long-Term Disability and Life Insurance.

• 401(k) plan with employer matching up to 3.5% available after 60 days.

• Community Service Day.

• 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving, in addition to a floating holiday.

• High-speed internet reimbursement.

• Company-provided computer and monitors.

• Tuition reimbursement for accredited degree programs.

• Paid New Parent Leave for adoption or birth.

• Pet insurance.

• Mental health benefits and EAP services through Spring Health.

• Eligibility for short-term incentives.