Solutions Architect

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

📋 Description

• Create comprehensive TPA operational workflows that encompass eligibility, claims, billing, and benefit administration.

• Convert vague cross-functional operational needs into well-structured solutions.

• Analyze current PBM systems and design future data flows and file exchanges.

• Collaborate with Pharmacy Strategy to define file formats, data exchange standards, and service level agreements (SLAs).

• Oversee PBM partner performance assessments and manage escalations effectively.

• Facilitate the onboarding of new vendors, addressing legal, data-sharing, and technical prerequisites until go-live.

• Work alongside PBMs to influence the development of products for both current and prospective clients.

• Create training materials and provide education to Account Management, Implementation, and Tech Ops teams.

• Keep track of drug cost containment, PMPM performance, and vendor cost outcomes.

• Identify opportunities for cost savings.

• Uphold pricing structures and rebate guarantees.

• Negotiate rebate and pricing agreements.

• Ensure leadership has insight into TPA and PBM operational health.

• Represent program performance during client reviews.

• Develop standard operating procedures (SOPs) and documentation that supports continuous improvement.

⛳️ Requirements

• A minimum of 7 years of experience in healthcare, TPA operations, product development, systems architecture, implementation, or related areas.

• Familiarity with PBM operations, data file formats, data dictionaries, and compliance standards.

• Experience with pharmaceutical rebate frameworks, formulary management, and drug cost containment methods.

• Understanding of legal and regulatory frameworks governing PBM operations and data sharing, including HIPAA and CMS.

• Proven ability to map complex processes and create end-to-end workflow designs.

• Acquainted with data management systems and analytics tools.

• Knowledgeable about PBM data file formats and data exchange protocols.

• Insight into rebate and pricing agreement structures.

• Proficient in process documentation and tools for SOP development.

🏝️ Benefits

• Competitive base salary.

• Comprehensive medical and dental coverage through our own health solutions.

• Unlimited paid time off (PTO).

• Access to mental health support.

• Retirement planning assistance.

• Financial protection options.

• Opportunities for professional development with clear career progression and dedicated learning budgets.

• A mission-driven culture where diverse perspectives create a meaningful impact.

• Wellness programs.

• Additional employee perks.

• Complete benefits package starting from day one.