Pharmacy Design Consultant

About the role

This role is responsible for the end-to-end development and ongoing maintenance of client Implementation Guides, which are essential for accurately configuring pharmacy benefits. The position requires expert-level knowledge of prescription benefits, strong systems proficiency, and the ability to interpret complex plan design documentation from other carriers. The Pharmacy Design Consultant will partner closely with internal teams and external stakeholders to ensure that all plan designs align with client expectations while adhering to regulatory requirements and system capabilities.

Responsibilities

• Lead the end-to-end creation, validation, loading, and maintenance of pharmacy benefit plan designs/Implementation Guides (IGs).
• Develop and maintain client Implementation Guides, ensuring accuracy, clarity, and alignment with benefit requirements.
• Translate complex client benefit requests into actionable system configurations within established capabilities.
• Provide guidance to cross-functional teams, including Client Success, Operations, Compliance, and Operations.
• Recommend best practices for benefit design to ensure accuracy, efficiency, and consistency across clients.
• Provide support and a second set of eyes on all new client implementations testing.
• Work closely with implementation teams to ensure smooth client onboarding and benefit transitions.
• Support internal teams with benefit interpretation questions and technical clarifications.
• Stay current on ACA requirements, state regulations, and clinical program capabilities.
• Maintain version control and auditability of Implementation Guides.

Requirements

• Minimum of 3-5 years’ experience in pharmacy benefits, PBM operations, or healthcare plan configuration.
• Proven ability to interpret plan design documents from external carriers.
• Knowledge of ACA mandates and state-specific benefit rules.
• Strong time management and prioritization skills.
• Excellent communication and collaboration skills.
• Experience working cross-functionally with implementation or client-facing teams.
• Extremely detail-oriented and organized.

Preferred Qualifications

• Experience with benefit setup in a PBM system.
• Familiarity with health plan or TPA operations.
• Process improvement or documentation experience.
• Prescription claims adjudication experience.

About the Company

Benecard Services, LLC has been administering carve-out, fixed-rate insured prescription drug benefit programs since 1990. Benecard is a full-service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. Headquartered in Lawrenceville, New Jersey.

BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused clinical expertise. Headquartered in Bonita Springs, Florida.

National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations, and Coalitions for over 40 years. NVA offers cost-effective, customized vision benefit programs that are clinically integrated. Headquartered in Clifton, New Jersey.