PBM Operations Associate

ABOUT THE ROLE:

Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers.

The PBM Operations Associate is a member of the Rightway Data Operations team, reporting to the Manager, Data Operations. This role provides day-to-day support of eligibility, accumulator, and claims extract file feeds and data — ensuring files are received, processed, and delivered accurately and on time.

WHAT YOU’LL DO:

Support the execution of eligibility and accumulator file feeds and interfaces, from implementation through ongoing operations and maintenance.
Support claims extract file feeds, helping ensure data is accurate, complete, and delivered to external stakeholders on schedule.
Serve as a day-to-day resource for eligibility, accumulator, and claims extract data needs.
Collaborate with engineering, client success, implementations, benefit administration, and other internal stakeholders to ensure eligibility, accumulator, and claims extract functions operate in accordance with requirements.
Monitor downstream vendor feeds (e.g., ID card fulfillment) and third-party integrations (e.g., health plans, TPAs, medical vendors) to help ensure deliverables are met on time; escalate and assist in troubleshooting issues as they arise.
Perform research and support troubleshooting of day-to-day inquiries or issues related to eligibility, accumulators, and claims extract/data feeds.
Maintain accurate, up-to-date documentation of eligibility, accumulator, and claims extract processes and internal controls.
Additional responsibilities may be assigned as business needs evolve. Please note that during peak seasons, such as open enrollment and plan renewals, this role may require additional hours to help meet critical deadlines.

WHO YOU ARE:

Bachelor's degree preferred. Relevant experience considered for exceptional candidates.
2-4 years of experience in healthcare operations, PBM, health plan, or data/eligibility operations; entry-level candidates with strong analytical skills are encouraged to apply.
Detail-oriented, organized, strong sense of ownership, ability to work in a fast-paced environment with shifting priorities, comfortable learning new systems and platforms, consultative with internal and external stakeholders.
Working knowledge of Excel; ability to research and troubleshoot data discrepancies; eligibility, accumulator, or claims file feed experience.