Manager, Pharmacy Adjudication, Affordability

Jobtailor; Connecticut; On-site; USD 100,000 - 150,000; Full time

Job summary

Jobtailor is seeking a subject matter expert in prescription adjudication in Connecticut. The role emphasizes COB sequencing rules, NCPDP standards, and plan design constraints across PBM, retail, and third-party affordability programs to optimize patient benefits.

You will partner with senior leadership to translate affordability strategies into executable adjudication logic, support curated affordability journeys, and drive end-to-end execution including requirements refinement and UAT

Qualifications

• 5–7 years of adjudication or related pharmacy operations experience.
• Strong analytical and problem-solving skills.
• Experience influencing across teams and stakeholders.
• Excellent communication and presentation abilities.
• Proficiency with Excel and PowerPoint.

Responsibilities

• Serve as SME in prescription adjudication including COB sequencing rules.
• Design and optimize plan sequencing strategies to maximize benefits.
• Translate affordability strategies into executable adjudication logic.
• Support affordability journeys reflecting real-world scenarios.
• Lead end-to-end adjudication initiatives: requirements, validation, UAT, defect resolution.

Skills

Adjudication

Pharmacy operations

Healthcare analytics

Cross-functional collaboration

Excel

PowerPoint

UAT/testing

Tools

NCPDP standards

IT collaboration

Job description

Serve as a subject matter expert in prescription adjudication, with deep expertise in: Coordination of Benefits (COB) sequencing rules, NCPDP standards and transaction logic, plan design constraints across PBM, retail, and third-party affordability programs
Design, configure, and optimize complex plan sequencing strategies that maximize utilization of patient benefits
Partner with senior leadership to translate affordability strategies into executable adjudication logic and workflows.
Support the development of curated affordability journeys by ensuring adjudication pathways reflect real-world patient scenarios
Identify, quantify, and prioritize patient affordability opportunities using pharmacy claims and performance data to reduce out-of-pocket costs and cost-related abandonment.
Manage multiple concurrent initiatives, balancing priorities, timelines, and interdependencies across stakeholders.
Support end-to-end execution of adjudication and affordability initiatives, including requirements refinement, configuration validation, UAT planning and execution, defect identification and resolution.

Requirements

• 5–7 years of experience in adjudication, pharmacy operations, PBM operations, healthcare technology, or analytics.
• Strong analytical and problem-solving skills.
• Experience collaborating across teams and influencing outcomes.
• Excellent communication and presentation skills.
• Proficiency in Excel and PowerPoint.
• 7+ years experience with affordability programs such as coupons or discount card processing or contracting (preferred).
• Knowledge of pharmacy adjudication or COB processes (preferred).
• NCPDP membership experience (preferred).
• Experience with UAT, testing, or IT collaboration (preferred).
• Experience working in cross-functional environments (preferred).