Healthcare TPA & PBM Solutions Architect

Personify Health, Inc.; United States; On-site; USD 85,000 - 118,000; Full time

Benefits offered by this job

Salary and benefits from day one

Medical and dental coverage

Unlimited PTO

Mental health support

Career development

Job summary

Personify Health, Inc. is seeking an experienced architect to turn pharmacy complexity into client wins. You will design end-to-end PBM/TPA workflows, aligning eligibility, claims, billing, and benefit administration to scale with client needs.

You will collaborate with cross-functional teams to map current-state systems to future-state data flows, negotiate data standards, and drive product offerings with PBMs to deliver compliant, production-ready solutions that improve client outcomes.

Qualifications

• Experience with data management systems and analytics tooling.
• PBM data file formats and data exchange standards.
• Understanding rebate and pricing agreement structures.
• Familiarity with process documentation and SOP development tools.

Responsibilities

• Architect end-to-end TPA solutions across eligibility, claims, billing, and benefit administration.
• Translate complex requirements into structured solutions for cross-functional teams.
• Own PBM solution design and map current-state to future-state data flows and file exchanges.
• Negotiate data standards and SLAs to protect data integrity and client outcomes.
• Manage PBM partnerships, lead vendor onboarding and escalation processes.
• Shape PBM product offerings in collaboration with PBMs for current and prospective clients.
• Develop training materials to educate teams on PBM landscape and TPA operations.
• Track financial performance and flag savings opportunities for clients.
• Manage pricing and rebates, and negotiate pricing agreements.

Skills

Data management systems

PBM data file formats

Rebate and pricing structures

SOP documentation tools

Job description

Personify Health, Inc. is seeking an experienced architect to turn pharmacy complexity into client wins. You will design end-to-end PBM/TPA workflows, aligning eligibility, claims, billing, and benefit administration to scale with client needs.

You will collaborate with cross-functional teams to map current-state systems to future-state data flows, negotiate data standards, and drive product offerings with PBMs to deliver compliant, production-ready solutions that improve client outcomes.