Solutions Architect
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Job Description
Solutions Architect designing PBM and TPA workflows for Personify Health’s personalized health platform. Leading data standards, vendor partnerships, pricing, rebates, and operational performance.
Responsibilities:
- Design end-to-end TPA operational workflows across eligibility, claims, billing, and benefit administration
- Translate ambiguous cross-functional operational requirements into structured solutions
- Map current-state PBM systems and build future-state data flows and file exchanges
- Partner with Pharmacy Strategy to establish file formats, data exchange standards, and SLAs
- Lead PBM partner performance reviews and escalation management
- Drive new vendor onboarding, including legal, data-sharing, and technical requirements through go-live
- Partner with PBMs to influence product development for current and prospective clients
- Develop training materials and educate Account Management, Implementation, and Tech Ops
- Monitor drug cost containment, PMPM performance, and vendor cost outcomes
- Identify savings opportunities
- Maintain pricing structures and rebate guarantees
- Negotiate rebate and pricing agreements
- Provide leadership visibility into TPA and PBM operational health
- Represent program performance in client reviews
- Build SOPs and documentation supporting continuous improvement
Requirements:
- 7+ years of experience in healthcare, TPA operations, product, systems architecture, implementation, or related fields
- Background in PBM operations, data file formats, data dictionaries, and compliance requirements
- Experience with pharmaceutical rebate structures, formulary management, and drug cost containment strategies
- Working knowledge of legal and regulatory requirements governing PBM operations and data sharing, including HIPAA and CMS
- Track record mapping complex processes and building end-to-end workflow designs
- Knowledge of data management systems and analytics tooling
- Knowledge of PBM data file formats and data exchange standards
- Knowledge of rebate and pricing agreement structures
- Knowledge of process documentation and SOP development tools
Benefits:
- Competitive base salary
- Comprehensive medical and dental through our own health solutions
- Unlimited PTO
- Mental health support
- Retirement planning
- Financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact
- Wellness programs
- Other employee perks
- Full benefits package starting day one
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