Client Integration Specialist (Pharmacy Benefits)

Ventegra, Inc.; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Ventegra, Inc. is seeking a detail-oriented pharmacy claims adjudication expert to join our collaborative team in the United States.

You will configure benefit plans, maintain formulary updates, and lead client onboarding for PSA, V340B, and CMM solutions to deliver excellent service. In this fast-paced role, you’ll analyze claims data, ensure data integrity, and collaborate across Clinical, IT, Ops, and Account Management to drive improvements while staying current on PBM trends and regulatory

Qualifications

• Experience in a pharmacy, healthcare, or customer service setting.
• Certified Pharmacy Technician (CPhT) is a plus.
• Detail oriented with strong analytical skills.
• Ability to configure PBM plans and formulary updates.

Responsibilities

• Serve as subject matter expert on PBM systems and claims adjudication platforms.
• Configure and maintain client benefit plans, copays, accumulators, and formulary updates.
• Lead client onboarding and integration projects for benefit structures and system configurations.
• Perform audits and QA evaluations to ensure data integrity and compliance.
• Analyze claims data to identify discrepancies and improvement opportunities.
• Collaborate with Clinical, IT, Operations, and Account Management teams to resolve issues.
• Monitor formulary files for timely updates aligned with requirements.
• Provide feedback for process improvements and system enhancements.
• Document and communicate system changes clearly to clients.
• Stay current on PBM industry trends, regulatory changes, and system capabilities.

Skills

Detail oriented

Team player

Problem solving

Initiative

Deadline driven

Multitasking

Prioritization

Collaboration

Education

Certified Pharmacy Technician (CPhT)

Job description

This position is ideal for someone who is eager to expand their expertise in pharmacy claims adjudication, benefit configuration, and formulary management—while working in a collaborative, fast-paced environment that values innovation and continuous improvement. You’ll be at the forefront of implementing and optimizing our Pharmacy Services Administration (PSA), V340B, and Clinical Medication Management (CMM) solutions, ensuring our clients receive exceptional service and support. We are committed to improving healthcare outcomes through transparency, technology, and collaboration. Our team is composed of industry experts who are passionate about transforming the healthcare landscape and delivering value to our clients and the communities they serve.

Duties and Responsibilities

• Serve as a subject matter expert on pharmacy benefit management (PBM) systems and claims adjudication platforms.
• Configure and maintain client benefit plans, including plan design, copay structures, accumulators, and formulary updates.
• Lead client onboarding and integration projects, ensuring accurate and timely implementation of benefit structures and system configurations.
• Perform regular audits and quality assurance evaluations to ensure data integrity and compliance with client specifications.
• Analyze claims data and system outputs to identify discrepancies, trends, and opportunities for improvement.
• Collaborate with cross-functional teams (e.g., Clinical, IT, Operations, Account Management) to resolve issues and enhance service delivery.
• Monitor and maintain formulary files, ensuring timely updates and alignment with clinical and contractual requirements.
• Provide feedback and recommendations for process improvements and system enhancements.
• Document and communicate system changes, updates, and client-specific configurations clearly and effectively.
• Stay current on PBM industry trends, regulatory changes, and system capabilities to support continuous innovation.

Required Skills and Abilities

• Detail oriented/attention to detail
• Self- starter while working well in a strong team environment
• Independently solving problems
• Take initiative to plan and complete assigned work with high level accuracy
• Work well under pressure and meet tight deadlines
• Multitask and shifts priorities
• Balance competing demands for time and prioritize workload to meet strict deadlines
• Collaborate with others and work effectively in a team environment

Education and Experience

• Experience: Previous experience in a pharmacy, healthcare, or customer service setting is highly desired.
• Certified Pharmacy Technician (CPhT) is a plus

Work environment requirements

A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally.