Pharmacy Benefits Analytics & Operations Lead

KAI Partners, Inc.; Roseville (CA); On-site; USD 120,000 - 150,000; Full time

Job summary

KAI Partners, Inc. is seeking Pharmacy Benefits Operations Consultants to serve as strategic advisors and analytical experts, responsible for assessing business needs, interpreting PBM requirements, and delivering data-driven insights that support project success.

They conduct in-depth business and data analysis, request and evaluate reports, and synthesize findings into actionable conclusions. Consultants may also coordinate validation of pharmacy business rules and claims adjudication

Qualifications

• Bachelor’s degree in health administration, public health, or a related field is required.
• PM/CSM and pharmacy background are preferred.
• Experience with PBM operations, claims processing, and CMS/state reporting is expected.

Responsibilities

• Apply expert PBM knowledge to validate business rules, claims processing, and implementation readiness.
• Assess federal and state funding implications, align with CMS reporting and compliance.
• Conduct detailed business analysis to document needs, goals, and system requirements.
• Collaborate cross-functionally with IT, operations, pharmacy, and healthcare staff.

Skills

PBM knowledge

Analytical skills

Communication skills

Stakeholder management

Cross-functional collaboration

Education

Bachelor’s degree in Health Administration, Public Health, Business Administration, Information Systems, Pharmacy, or related field

Master’s degree (MPH, MBA, MHA, or related discipline)

PMP or Certified Scrum Master (CSM)

Pharmacy Technician Certification (CPhT) or pharmacy background

Tools

MMIS

PBM platforms

Claims processing

Job description

KAI Partners, Inc. is seeking Pharmacy Benefits Operations Consultants to serve as strategic advisors and analytical experts, responsible for assessing business needs, interpreting PBM requirements, and delivering data-driven insights that support project success.

They conduct in-depth business and data analysis, request and evaluate reports, and synthesize findings into actionable conclusions. Consultants may also coordinate validation of pharmacy business rules and claims adjudication