Pharmacy Benefits & Audit Coordinator (Hybrid/Remote)

WPS—A health solutions company; Kentucky; Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid options available

Bonus opportunities

401(k) with employer match

Job summary

WPS—A health solutions company seeks a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and build expertise in the PBM claims system, supporting the Health Services Contract Center and internal teams to resolve escalated customer issues.

The role emphasizes analyzing pharmacy claims data, guiding operational decisions with PBM partners, and collaborating across Call Center, Sales, and Product teams to improve performance and cost outcomes.

Qualifications

• High school diploma and work-related experience.
• 5+ years in a Pharmacy Benefit role, working for a Health Insurer, PBM, or equivalent.
• Knowledge of health benefits carrier concepts and PBM operations.
• Understanding of pharmacy claims processing and formulary management.
• Excellent communication and relationship management with internal/external partners.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to manage multiple priorities.

Responsibilities

• Serve as subject-matter expert on pharmacy benefits and PBM capabilities.
• Interpret pharmacy claims data, evaluate trends, and address issues.
• Decide PBM operational needs and maintain performance-monitoring processes.
• Collaborate across Call Center, Sales, Account Management, Marketing, and Health Services.
• Coordinate PBM employer group reporting and support external discussions.
• Work with Risk Management on high-cost claims and denials.

Skills

Analytical thinking

Problem-solving

Communication skills

Attention to detail

Time management

Education

High school diploma

Associate’s degree (Preferred)

Job description

WPS—A health solutions company seeks a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and build expertise in the PBM claims system, supporting the Health Services Contract Center and internal teams to resolve escalated customer issues.

The role emphasizes analyzing pharmacy claims data, guiding operational decisions with PBM partners, and collaborating across Call Center, Sales, and Product teams to improve performance and cost outcomes.