PBM Data Operations Coordinator

About the role

The PBM Data Operations Coordinator supports data exchange operations across eligibility and claims accumulator processes. This role provides technical and analytical expertise for electronic data interchange (EDI) transactions, including eligibility (834) and claims accumulator feeds (e.g., 837). The Coordinator serves as a subject matter expert and key liaison between internal teams, clients, third-party administrators (TPAs), and external vendors.

Key Responsibilities

• Capture and analyze client requirements, mapping specifications, and goals during onboarding.
• Support carrier and vendor testing for new eligibility file implementations.
• Maintain monitoring of inbound and outbound eligibility file exchanges; proactively identify and resolve errors.
• Research, troubleshoot, and remediate issues related to electronic eligibility data and system processing.
• Perform quality reviews of eligibility tasks, fixes, and enhancements.
• Manage file handling, tracking tools, and reporting accuracy.
• Conduct upfront analysis of accumulator feeds from clients, TPAs, and medical carriers.
• Ensure timely and accurate upload of accumulator amounts into the system.
• Proactively identify and correct discrepancies or file issues.
• Analyze edit reports and coordinate corrective actions.
• Serve as the business owner for Integrated Max Out-of-Pocket (TMOOP) processing.
• Provide requirements for new interfaces and system enhancements related to eligibility and accumulator data.
• Collaborate with IS and other internal teams to address process gaps, inefficiencies, or platform improvements.
• Aid in user acceptance testing (UAT) for system development requests.
• Participate in internal and external meetings, calls, and vendor/client discussions.
• Provide technical support to implementation teams and external stakeholders.
• Document fixes, enhancements, and process updates to ensure operational quality.

Qualifications

• Ability to work independently and take initiative.
• Experience testing, analyzing, researching, verifying, entering, or correcting electronic data.
• Experience with eligibility (834) files and/or accumulator-related data feeds.
• Working knowledge of electronic file formats such as 834 or 837.
• Proficiency in Microsoft Excel (moderate skill level).
• Strong analytical and critical-thinking skills.
• Organizational skills and attention to detail.
• Verbal and written communication skills.
• Ability to multitask, prioritize, and work effectively with teams.
• Ability to analyze and research data to identify and resolve issues.

Preferred Qualifications

• 1+ years’ experience in electronic claims accumulator transmission.
• Experience with custom client file layouts and healthcare industry EDI standards.
• Experience with TPA, carrier, or PBM environments.
• Familiarity with post-edit reporting or accumulator discrepancy analysis.
• Prior involvement with UAT or system development initiatives.

Featured Benefits

• Competitive salary
• Vacation and Sick/Personal Time
• Medical Insurance
• Hearing Program Discount
• Short- and Long-Term Disability Insurance
• Life Insurance
• Flexible Spending Account
• 401(k)
• Employee Referral Program
• Employee Recognition Programs
• Tuition Reimbursement
• Professional Development and Training

Contact Information

BeneCard Services, LLC
Website: http://www.benecard.com

BeneCard PBF
Website: http://benecardpbf.com

National Vision Administrators
Website: http://www.e-nva.com

We are an Equal Opportunity employer.