Principal TPM – PBM Benefit Data Integrations
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Job Description
Principal TPM managing complex PBM benefit data integrations for healthcare tech company Prescryptive Health. Overseeing program execution and ensuring data quality across various platforms.
Responsibilities:
- Own end-to-end delivery of PBM benefit data integration initiatives impacting claims, eligibility, accumulators, and related platforms.
- Identify, assess, and manage program risks, including coordinating root-cause remediation efforts in partnership with engineering and operations teams.
- Drive cross-functional alignment on technical and operational requirements to ensure scalable, compliant integration design.
- Design and validate scalable solution architectures supporting claim processing, eligibility, accumulators, and reporting.
- Partner cross-functionally with business stakeholders, internal development teams, and external vendors to improve systems, workflows, and data accuracy.
- Own delivery timelines, milestone tracking, and executive-level reporting for benefit data integration initiatives.
- Coordinate implementation readiness including rollback planning, validation artifacts, and post-deployment support models.
- Ensure adherence to security standards, data governance practices, and operational policies.
- Drive implementation validation including testing, rollback planning, data migration, and post-install support.
Requirements:
- Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or related quantitative field (required).
- 10+ years of progressive experience in healthcare analytics, PBM operations, data integration, or business systems analysis (required).
- Experience within a PBM or healthcare claims processing environment (required).
- Deep expertise in PBM benefit configuration, adjudication logic, eligibility, and accumulator integrations.
- Advanced proficiency in SQL (advanced querying and data investigation)
- Experience managing delivery timelines, risks, dependencies, and remediation coordination.
- Working knowledge of ANSI/NCPDP Telecommunication Standard
- Working understanding of PBM or TPA claim processing
- Experience with data ETL processes and file delivery mechanisms (SFTP, PGP)
- Experience with job scheduling automation and alerting tools
- Microsoft Azure cloud experience, including blob storage
- Familiarity with C#, Java, JavaScript, Python, or R preferred
- Integration testing and UAT coordination experience
Benefits:
- Flexible time off, including 12 paid holidays
- 401k match plus 100% employer paid medical, dental, and vision
- Company contribution to Health Savings Account
- Stock options
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