PBM Operations Associate

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

📋 Description

• Assist in cross-functional projects within PBM operations, encompassing go-live management and various strategic initiatives.

• Aid in the implementation of client and plan services, collaborating with teams to ensure precise benefit setup, testing, and a seamless go-live process.

• Offer pre- and post-audit support, overseeing deliverables and tracking to guarantee timely and accurate completion.

• Facilitate the involvement of Operations in internal projects requiring operational insight or assistance.

• Monitor project timelines, deliverables, and action items, raising flags for any risks or delays that may occur.

• Keep well-organized documentation, including SOPs and process trackers, to enhance visibility across projects and teams.

• Collaborate with cross-functional stakeholders, such as Clinical, Client Services, IT, and Compliance, to ensure operational readiness for new initiatives and process modifications.

• Assist in data validation and reporting related to PBM operations projects, including claims, eligibility, and formulary data.

• Support CMS reporting requirements, such as Section 111 Medicare Secondary Payer (MSP) data submissions and Retiree Drug Subsidy (RDS) reporting, by tracking deadlines, reconciling data, and addressing discrepancies.

• Recognize opportunities to enhance PBM operations workflows and aid in implementing process improvements.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor's degree or equivalent work experience.

• A minimum of 2 years of experience in PBM, pharmacy benefits, or healthcare operations is preferred.

• Familiarity with accreditation processes (e.g., URAC) or government programs (e.g., EGWP) is advantageous, although not mandatory.

• Understanding of CMS regulatory reporting, such as Section 111 MSP or RDS, is beneficial, though not required.

• Strong organizational abilities, capable of managing multiple projects and deadlines concurrently.

• Excellent written and verbal communication skills.

• Comfortable coordinating with various teams and facilitating progress without direct reporting authority.

• Detail-oriented with a proactive, problem-solving approach.

• Experience in supporting audits or accreditation processes.

• Background in a fast-paced, high-growth operations environment.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Opportunities for professional development and career advancement.

• Flexible working arrangements.

• Competitive compensation and performance-based incentives.