PBM RFP & Pricing Lead - Remote

Digital Insurance LLC; United States; Remote; USD 90,000 - 150,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Retirement plan

Learning & development

Job summary

OneDigital is seeking a seasoned PBM RFP & Pricing Lead to own and optimize the end-to-end PBM RFP process. You will drive pricing models, underwriting analyses, and bid evaluation while mentoring the RFP team.

The role emphasizes AI-driven capabilities, scalable tools, and cross-functional collaboration with audit, analytics, and consulting teams. The base pay ranges nationwide, with performance-based incentives.

Qualifications

• 5–10+ years of experience in PBM consulting, underwriting, pricing, or RFP strategy.
• Deep understanding of PBM financial models, including AWP discounts, MAC pricing, and ingredient cost structures.
• Rebate guarantees (PMPM, per-claim, hybrid models); specialty pharmacy economics and trend drivers.
• Experience building and/or evaluating PBM RFPs and bidder responses.

Responsibilities

• RFP Process Ownership & Optimization: Own and improve end-to-end PBM RFP process across strategy to finalist selection.
• PBM Financial Modeling & Underwriting: Lead pricing models, analyze cost drivers and validate assumptions.
• Bid Evaluation & Strategy: Translate proposals into clear financial insights and support negotiations.
• Product, AI & Capability Development: Own RFP tools and AI-driven capabilities to enhance the process.

Skills

PBM knowledge

Pricing models

Excel

SQL

Data tools

AI tools

Analytical thinking

Communication

Stakeholder mgmt

Education

Bachelor's degree in a relevant field

Tools

SQL

Power BI

Tableau

RFP platforms

Job description

Are you looking to accelerate your career without having to hide your authentic self - a place where you can be you? A career that’s making a bigger impact on the world? At OneDigital, we are on a mission to help people do their best work and live their best lives. From the services we offer to the way we show up for each other each day, we are fueling dreams, achieving big goals, and embracing each other’s truest selves. We understand that pursuing a new job is a big deal. Maybe you’re afraid you won’t fit in. Well, here’s the good news. For us, the days of “fit in to get in” are over and being different is not a barrier to getting ahead. Greatness comes in all shapes, sizes, colors, and experience levels. If you are looking for a people-first culture that is wired for growth, driven to serve, and totally committed to having your back, give us a shot. Your best life awaits.

Must be eligible to work in the United States without the need for work visa or residency sponsorship. We kindly ask that external recruiters, agencies, and search firms do not contact our hiring managers or employees directly regarding open positions. All candidate submissions must go through our official application process and must be made aware to our internal Talent Acquisition team to verify candidate ownership. Unsolicited resumes or candidate profiles sent to OneDigital without a prior signed agreement will be considered the property of OneDigital. In such cases, OneDigital reserves the right to pursue and hire those candidates without any financial obligation to the agency or recruiter.

Position Overview

We are seeking a highly experienced PBM RFP & Pricing Lead to own and enhance our end-to-end pharmacy RFP process. This is a hands‑on, strategic role focused on product ownership of the RFP process, pricing model development, and PBM financial evaluation. This role reports to and partners closely with the Director of PBM Performance, taking strategic direction while owning execution, process development, and advancement of the RFP function. The ideal candidate brings deep expertise in PBM underwriting, pricing mechanics, and bid evaluation, with the ability to translate complex financial proposals into clear, actionable insights. This individual will play a critical role in building scalable processes, improving modeling capabilities, and leveraging AI‑driven solutions to modernize and accelerate the RFP lifecycle. This role will also provide mentorship and help support the development and growth of the RFP function.

Key Responsibilities

• RFP Process Ownership & Optimization Own and continuously improve the end-to-end PBM RFP process, from strategy and development through evaluation and finalist selection Standardize RFP structures, question sets, and evaluation methodologies across clients Identify opportunities to streamline workflows and implement tools/technology to increase efficiency and scalability Mentor & lead junior team members and help build and mature the RFP team’s capabilities
• PBM Financial Modeling & Underwriting Analysis Lead development and refinement of PBM pricing models (discount guarantees, rebate structures, admin fees, specialty pricing, etc.) Evaluate and normalize bidder financial proposals to enable true “apples-to-apples” comparisons Analyze key drivers of cost (ingredient cost, utilization, rebates, clinical programs) and identify risk/opportunity areas Validate underwriting assumptions and challenge PBM pricing methodologies
• Bid Evaluation & Strategy Translate complex PBM proposals into clear financial and strategic insights for internal teams and clients Identify pricing risks, hidden fees, and contractual nuances that impact total cost of care Support finalist negotiations by providing data-driven recommendations and scenario modeling
• Product, AI & Capability Development Act as a “product owner” for RFP tools, models, and analytics (Excel-based, SQL-driven, or platform-based solutions) Assist in the design, development, and implementation of AI-driven capabilities to enhance the RFP process, including: Automated extraction of PBM contract terms and pricing components AI-assisted summarization and comparison of bidder responses Predictive modeling and benchmarking of PBM pricing outcomes Partner with analytics and engineering resources to translate RFP workflows into scalable systems and tools Continuously identify opportunities to leverage AI and automation to reduce manual effort, improve accuracy, and increase speed
• Cross‑Functional Collaboration Work closely with audit, analytics, and consulting teams to align RFP outputs with downstream audit and monitoring strategies Support business development efforts by contributing to proposals and client presentations Serve as a subject matter expert on PBM pricing and market dynamics

Qualifications

• 5–10+ years of experience in PBM consulting, underwriting, pricing, or RFP strategy
• Deep understanding of PBM financial models, including AWP discounts, MAC pricing, and ingredient cost structures
• Rebate guarantees (PMPM, per-claim, hybrid models) Specialty pharmacy economics and trend drivers Administrative fees and contract financial terms
• Experience building and/or evaluating PBM RFPs and bidder responses
• Advanced Excel skills required; experience with SQL, data tools (Qlik, Power BI, Tableau), or RFP platforms is a strong plus
• Exposure to AI tools, automation, or data product development (or strong interest in applying AI to business processes)
• Strong analytical and problem‑solving skills with high attention to detail
• Ability to translate complex data into clear, executive-level insights
• Self-starter who thrives in a build/scale environment

What Success Looks Like

• A standardized, scalable PBM RFP process with reduced reliance on individual knowledge
• Robust, repeatable pricing models that improve accuracy and confidence in financial comparisons
• Integration of AI and automation to streamline RFP intake, analysis, and output generation
• Clear, defensible recommendations that drive better client outcomes and measurable savings

Salary & Benefits

• The typical base pay range for this role nationwide is $90,000 to $150,000 per year.
• Your base pay is dependent upon your skills, education, qualifications, professional experience, and location.
• In addition to base pay, some roles are eligible for variable compensation, commission, and/or annual bonus based on your individual performance and/or the company’s performance.
• We also offer eligible employees health, wellbeing, retirement, and other financial benefits, paid time off, overtime pay for non-exempt employees, and robust learning and development programs.
• You will receive reimbursement of job-related expenses per the company policy and may receive employee perks and discounts.

OneDigital is an equal opportunity employer. Not only as a matter of standard, but to honor and celebrate our differences. We believe that the power of ONE starts with you. We are committed to cultivating and preserving a culture that celebrates diversity, insists on equity and inclusion, and connects us. Ensuring our people feel seen, valued, respected, and supported is fundamental to our core values and business goals. OneDigital provides equal employment opportunities to all employees and applicants for employment regardless of their: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy (including childbirth, lactation and related medical conditions), national origin or ancestry, citizenship or immigration status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law (collectively, “protected characteristics”). A copy of the Federal EEO poster is linked here. Pursuant to local Fair Chance Ordinances, we will consider qualified applications with arrest or conviction records for employment. For applicable candidates, the following ordinances are linked here to inform you of your rights as an applicant: City and County of San Francisco City of Los Angeles County of Los Angeles Employment decisions shall comply with all other applicable federal, state and city/county laws prohibiting discrimination in employment. OneDigital complies with all criminal history inquiry [or ‘ban the box’] laws in California, Connecticut, Colorado, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington. In short, we believe in hiring the most qualified applicant for the position, regardless of background. This posting will remain live while OneDigital is actively accepting applications. Once candidates have been selected, the posting will be removed.

OneDigital understands the immense responsibility and opportunities provided by Artificial Intelligence. We utilize advanced Artificial Intelligence [AI] technologies to enhance our recruitment process. This includes using AI to filter candidates based on their qualifications and to rediscover potential candidates from our existing applicant pool. Our AI systems help us efficiently identify the best fit for our open positions, ensuring a streamlined and effective hiring experience. However, AI does not replace the humans in our process. If you have concerns about our use of AI, you may opt out where laws allow. If you have questions about our hiring policies and practices, we would be happy to discuss upon receiving your application. We hope to welcome you to OneDigital and look forward to hearing from you. Thank you for your interest in joining the OneDigital team! OneDigitalis a growing organization of caring, collaborative, and driven professionals who have dedicated their careers to‐improving the lives of millions of people every day. We are‐in the people business. We offer employers and individuals insurance, financial services and HR consulting services, which improve the wellbeing, health and financial security of people across the US. Learn More At OneDigital, our promise is to help you do your best work and live your best life. Working at OneDigital is more than a career,it isਊ calling to serve. It is “a career of consequence.” We set the bar high and the pace fast. We value growth and learning and always make time to celebrate our successes. We have each other's back and usewords like love and family in the same sentence with achievement and accountability. Join the OneDigital Professional Network We believe in living with purpose and thriving both as individuals and as communities. We call this "walking the talk", and it’s why we offerthe same total-wellbeingbenefits to our people as we do our clients. It also means feeling safe to speak up, being seen and respected for who you truly are, and being cared for by your leaders and team members. Learn more: Diversity, Equity, Inclusion, and Belonging at OneDigital Careers at OneDigital Culture at OneDigital Follow us on LinkedIn