Key skills
Project ManagementCritical Thinking
About this role
Role Overview
- Execute complex formulary coding within adjudication systems, ensuring clinical intent is accurately reflected in system logic.
- Utilize Advanced Excel and Google Sheets (VLOOKUP, Index/Match, Pivot Tables, and complex nested formulas) to manipulate large datasets.
- Apply deep knowledge of PBM hierarchies and adjudication logic to troubleshoot rejected claims and optimize system performance.
- Manage multiple high-priority projects simultaneously, shifting priorities fluidly to meet urgent client needs or business deadlines.
Requirements
- Minimum of 2 years of direct experience in a PBM or Managed Care environment.
- Having an active Pharmacy Technician license or registration is highly preferred.
- Expert-level capability in Excel and Google Sheets, specifically for data cleaning, transformation, and complex formula building.
- Proven experience in formulary management systems and a strong grasp of adjudication coding and hierarchy structures.
- Deep knowledge of Medispan drug information or similar drug database platforms.
- Analytical Thinking: Exceptional critical thinking skills and the ability to solve complex problems independently.
- Detail Orientation: Meticulous attention to detail when managing high-stakes data updates.
- Adaptability: The ability to thrive and remain composed in a demanding, constantly evolving landscape.
- Project Management: Strong organizational skills with the ability to manage timelines and prioritize tasks according to business and client urgency.
- Systems Thinking Mindset: The ability to look beyond the immediate task to understand how system updates ripple through the entire system.
Benefits
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- Paid Company Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities