Pharmacy Benefit Operations Associate

Job Summary

Working remotely, the full-time Pharmacy Benefit Operations Associate will manage the configuration and maintenance of benefits and claims adjudication rules, ensuring accurate setup and compliance with client requirements.

Key responsibilities

• Review and validate client benefit design documentation, collaborating with implementation and client success teams to address any gaps
• Configure client benefit designs in the claims adjudication platform and execute test claim scenarios to ensure accuracy prior to go-live
• Research and resolve inquiries related to claims adjudication while maintaining audit-ready documentation of benefit setups and testing evidence

Required qualifications

• Bachelor's degree preferred; relevant experience considered for exceptional candidates
• 1-3 years of experience in pharmacy benefit management, specifically in claims adjudication or benefit configuration
• Pharmacy Technician certification or related pharmacy experience is highly desirable
• Proficiency in structured tools such as Excel and claims platforms
• Ability to work effectively in ambiguous situations and manage multiple client deliverables against deadlines