Operations & Implementations Specialist (PBM)

Description

We are seeking a detail-oriented and personable Operations & Implementations Specialist to join our Pharmacy Benefit Management (PBM) team. This hybrid role bridges two critical functions—Operations and Implementations—ensuring accurate benefit configuration and smooth client onboarding. If you thrive in a fast-paced environment and enjoy both technical work and client interaction, this position is for you.

Requirements

You will accomplish this through:

Essential Job Duties

• Operations (First half to three-quarters of the year):
• Configure pharmacy benefit plan rules in our adjudication engine and portal tools.
• Perform QA, testing, and plan audits for new implementations and mid-year changes.
• Review claims for new groups/plans during the initial go-live month.
• Collaborate with Operations Analysts and Team Leads to prioritize and complete tasks.
• Implementations (Final quarter of the year):
• Assist the Implementation Manager with new client setups, plan changes, and TPA transitions.
• Communicate with clients, brokers, and TPAs to gather required information.
• Prepare and update plan documents, SBCs/SPDs, and maintain SharePoint resources.
• Update client portals with key attributes (fees, Section 111 data, etc.).
• Coordinate with Finance for billing setup and Account Management for advocacy and customizations.
  
  

Skills And Abilities

• Basic understanding of pharmacy benefits and operational logic (PBM experience preferred).
• Strong organizational and time management skills.
• Excellent communication skills—comfortable in client-facing interactions.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office and familiarity with portals or adjudication systems
• Preferred Experience in PBM operations or healthcare implementations.
• Familiarity with SBC/SPD review and benefit configuration.