Pharmacy Benefit Configuration Analyst (CPhT Preferred)

Pharmacy Benefit Configuration Analyst (CPhT Preferred)

About the Role

As part of our Benefit Configuration & Operations team, you’ll help set up and maintain client benefit plan designs and clinical programs within our PBM’s adjudication platform. You’ll work alongside internal subject-matter experts to understand how benefits function, analyze systems to identify inaccuracies, and escalate issues for timely resolution.

A background in pharmacy or benefits is highly preferred; however, expert-level proficiency is not required. Candidates with a solid foundational understanding and a strong learning mindset will be successful. You’ll receive comprehensive training tailored specifically to our organization’s workflows and quality standards, while collaborating closely with a supportive team.

Key Responsibilities

• Analyze and validate requests for plan design edits, clinical rule updates, formulary changes, and new program implementations.
• Translate client and internal benefit requests into accurate system configuration logic (copay, deductible, accumulator, network, formulary, UM edits, etc.).
• Conduct regression testing via claim adjudication to ensure accuracy before and after benefit changes.
• Maintain detailed documentation of all configurations and change requests for audit and historical purposes.
• Troubleshoot and resolve claim discrepancies, ensuring timely resolution and root-cause prevention.
• Work in close partnership with platform service delivery team to ensure potential issues are identified and resolved with minimal operational impact.
• Monitor and respond to error or exception reports; proactively identify and correct coding discrepancies.
• Prioritize and manage tasks to meet strict deadlines, respond to urgent requests, and address escalations efficiently.
• Collaborate closely with Clinical, Client Services, and Operations teams to ensure benefit alignment across departments.
• Support continuous improvement initiatives, process documentation, and automation opportunities.
• Maintain basic knowledge of NCPDP standards relevant to claims adjudication and system setup.
• Uphold confidentiality and compliance with HIPAA and company standards at all times.

What We’re Looking For

• Detail-oriented and analytical — enjoys solving complex logic puzzles and validating results with precision.
• Certified Pharmacy Technician (CPhT) preferred; pharmacy or PBM operations experience strongly valued.
• Proficient with Microsoft Office, particularly Excel and Access
• Exceptional organizational skills and comfort managing multiple projects in a fast-paced environment.
• Strong written and verbal communication; able to explain technical information clearly to non-technical audiences.
• Adaptable, eager to learn, and thrives in a growing, evolving organization.
• Customer-focused mindset with a high degree of accountability and professionalism.
• Positive team player who contributes to a culture of respect, integrity, and shared success.

Performance Expectations

• Complete standard client requests within SLA timelines.
• Demonstrate initiative in identifying system or process improvements.
• Communicate clearly, proactively, and constructively with internal and external partners.
• Consistently uphold company values of excellence, collaboration, and care.

Why Join Us

You’ll be joining a growing PBM where your precision and problem-solving directly improve member health outcomes and client trust. We are a mission-driven, people-first organization — passionate about doing what’s right for our clients and members while supporting each other’s growth.

If you’re looking for a career where your analytical skills meet meaningful impact — this is it.

Must live in Michigan.

Pay: $50,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Grosse Pointe Park, Michigan 48230

Salary : $50,000 - $60,000