PBM Operations Associate
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Job Description
PBM Operations Associate coordinating pharmacy-benefit implementations, audits, CMS reporting, and cross-functional projects. Supporting Rightway’s healthcare app mission to improve care and reduce costs.
Responsibilities:
- Support cross-functional projects across PBM operations, including go-live management and other strategic initiatives
- Assist with client and plan implementations, coordinating across teams to help ensure accurate benefit setup, testing, and a smooth go-live
- Provide pre- and post-audit support, managing deliverables and tracking to ensure timely, accurate completion
- Coordinate Ops involvement across internal projects that require operational input or support
- Track project timelines, deliverables, and action items, flagging risks or delays as they arise
- Maintain clear, organized documentation, including SOPs and process trackers, to support visibility across projects and teams
- Partner with cross-functional stakeholders, including Clinical, Client Services, IT, and Compliance, to help ensure operational readiness for new initiatives and process changes
- Support data validation and reporting tied to PBM operations projects, such as claims, eligibility, and formulary data
- Support CMS reporting obligations, including Section 111 Medicare Secondary Payer (MSP) data submissions and Retiree Drug Subsidy (RDS) reporting, helping track deadlines, reconcile data, and resolve discrepancies
- Identify opportunities to improve PBM operations workflows and help implement process improvements
- Perform other duties as assigned
Requirements:
- Bachelor's degree or equivalent work experience
- 2+ years of experience in PBM, pharmacy benefits, or healthcare operations preferred
- Exposure to accreditation processes (e.g., URAC) or government programs (e.g., EGWP) is a plus, though not required
- Familiarity with CMS regulatory reporting, such as Section 111 MSP or RDS, is a plus, though is not required
- Strong organizational skills, with the ability to manage multiple projects and deadlines simultaneously
- Excellent written and verbal communication skills
- Comfortable coordinating across teams and driving progress without direct reporting authority
- Detail-oriented with a proactive, problem-solving mindset
- Experience supporting audits or accreditation processes
- Experience in a fast-paced, high-growth operations environment
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