PBM Operations Associate

About Our Client

The organization operates in the pharmacy benefit management (PBM) sector, addressing the challenge of managing pharmacy spending to make medications more affordable for employees and their dependents. Since its founding in 2017, the organization has developed a transparent PBM model focused on supply chain optimization, supporting physician-patient relationships, and empowering consumers through navigation tools. Its mission is centered on improving healthcare experiences, outcomes, and costs.

About the Opportunity

The PBM Operations Associate supports the Data Operations team by managing eligibility, accumulator, and claims data feeds. This position ensures accurate and timely processing and delivery of critical data, helping maintain operational efficiency and data integrity across pharmacy benefit management activities. The role collaborates with internal teams and external partners to resolve data issues and support client requirements.

Responsibilities

• Manage the execution and ongoing maintenance of eligibility and accumulator file feeds and interfaces.
• Support accurate and timely delivery of claims extract file feeds to external parties.
• Serve as a resource for data needs related to eligibility, accumulators, and claims extracts.
• Collaborate with engineering, client success, implementations, and benefit administration teams to ensure data functions meet requirements.
• Monitor vendor feeds and third-party integrations to verify on-time deliverables, escalating and troubleshooting issues as needed.
• Research and resolve inquiries and issues related to eligibility, accumulator, and claims data feeds.
• Maintain accurate and up-to-date documentation of data processes and controls.
• Perform additional duties as required, including extended hours during peak periods.

Requirements

• Bachelor’s degree preferred; relevant experience may be considered.
• 2–4 years of experience in healthcare operations, PBM, health plan, or data and eligibility operations.
• Strong analytical skills and the ability to troubleshoot data discrepancies.
• Detail-oriented and organized, with the ability to manage shifting priorities in a fast-paced environment.
• Comfortable learning and working with new systems and platforms.
• Strong consultative and communication skills with internal and external stakeholders.
• Proficiency with Microsoft Excel.
• Experience with eligibility, accumulator, or claims file feeds.

Pay

Salary range: $65,000–$85,000 annually, plus bonus and equity. Compensation varies based on geographic location, experience, and qualifications.