PBM Operations Associate

Responsibilities

• Review client benefit design documentation for completeness and accuracy
• Configure client benefit designs in the claims adjudication platform, including plan parameters and copay structures
• Develop and execute test claim scenarios to validate benefit setup and perform regression testing
• Research and resolve inquiries related to claims adjudication and benefit configuration
• Partner cross-functionally with product, client success, implementation, and formulary teams
• Maintain audit-ready documentation of benefit setup and internal controls
• Track work across implementation and plan change trackers

Requirements

• 1-3 years of PBM experience in claims adjudication, benefit configuration, or testing/QA
• Bachelor's degree preferred; relevant experience considered
• Pharmacy Technician certification or related pharmacy experience highly desirable
• Strong attention to detail and ability to trace claim outcomes to configuration drivers
• Ability to navigate ambiguity and work from incomplete requirements
• Proficiency with Excel, Smartsheet, and claims platforms

About the Company

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Their products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient's care journey through a modern, mobile app.