Pharmacy Benefits & Audit Coordinator (Hybrid)

WPS—A health solutions company; Madison (WI); Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus and merit increases

401(k) with 100% match for 3% and 50%?

Competitive PTO

Health, dental, telehealth start DAY 1

Professional and LeadershipDevelopment

Job summary

WPS Health Solutions is seeking a Pharmacy Coordinator to lead audit processes for delegated PBM activities and become the knowledge base for internal teams on pharmacy benefits and system capabilities.

The role involves interpreting claims data, guiding actions on escalated issues, and partnering with PBM to maintain performance-monitoring processes. A background of 5+ years in pharmacy benefit roles is preferred.

Qualifications

• Strong communication and relationship management with internal and external partners.
• Analytical mindset with ability to interpret pharmacy claims and utilization data.
• Attention to detail and ability to juggle multiple priorities.

Responsibilities

• Serve as the primary SME for internal teams on pharmacy benefits and system capabilities.
• Interpret claims and utilization data, identify trends, and address issues.
• Make decisions on PBM operational needs and monitor performance processes.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to develop educational materials.
• Coordinate PBM employer group reporting and support external customer discussions.
• Work with Risk Management on high-cost claims and short-term health plan denials.
• Assist Plan Product with mask configuration and PBM collaboration on updates.
• Coordinate with PBM and pharmacy vendors for QIC presentations and program analyses.
• Quantify savings and outcomes for pharmacy programs and identify cost reductions.
• Other duties as assigned.

Skills

Communication skills

Relationship management

Analytical thinking

Problem-solving

Attention to detail

Education

Associate’s degree in business/healthcare

Job description

WPS Health Solutions is seeking a Pharmacy Coordinator to lead audit processes for delegated PBM activities and become the knowledge base for internal teams on pharmacy benefits and system capabilities.

The role involves interpreting claims data, guiding actions on escalated issues, and partnering with PBM to maintain performance-monitoring processes. A background of 5+ years in pharmacy benefit roles is preferred.