Employment Requirements
This opportunity is not open to C2C relationships or visa sponsorship.
Job Description
We are seeking an experienced professional with a background in pharmacy or medical fields and a strong understanding of pharmacy benefits management (PBM). This fully remote role requires working Arizona hours (8:00 AM – 4:30 PM) and involves supporting internal teams and external stakeholders in ensuring accuracy and quality in prescription benefit design and claim processing. The ideal candidate is analytical, organized, and capable of solving complex problems beyond basic data entry.
Responsibilities
• Analyze PBM prescription claim systems for benefit quality and accuracy.
• Provide support on medication benefit questions and issues.
• Monitor and investigate system setup problems and escalate as needed.
• Participate in quality initiatives, audits, and corrective action processes.
• Resolve escalated member and claim issues.
• Research and recommend solutions for benefit accumulations and discrepancies.
• Document benefit setup issues and maintain error tracking.
• Serve as a subject matter expert (SME) for benefit design and setup.
• Build reports and analyze data to support benefit design decisions.
• Manage benefit setup for renewals and new pharmacy plans, including drug code assignments.
Qualifications
• 5+ years of experience in the pharmacy or medical field.
• 5+ years of experience in prescription benefit administration.
• Experience with pharmacy claim systems (e.g., RxClaim) and vendor tools (rebates, formulary tools).
• Strong analytical and problem-solving skills.
• Experience managing complex projects and resource allocation.
• Ability to maintain and work with confidential information.
• Excellent communication and organizational skills.
• Proficient in handling benefit design within claim systems (not data entry).
Preferred Qualifications
• 3–5 years of experience with a pharmacy benefit manager (PBM) or in prescription claim administration.
• Experience with large-scale claims processing platforms.
• Familiarity with coding and analytics in vendor systems.
• Associate’s degree in a related field.
• Previous work in the healthcare industry.
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