Pharmacy Benefits & Audit Systems Specialist

WPS Health Solutions; Marion (IL); On-site; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid options

Performance bonus

401(k) match

Health insurance

Leadership development

Job summary

WPS Health Solutions seeks a Pharmacy Coordinator to oversee audit processes for PBM activities and to build expertise in the PBM's online claims system. You will assist internal teams and resolve escalated customer issues.

The role requires 5+ years in a Pharmacy Benefit setting, strong data interpretation skills, and collaboration across departments. Remote and hybrid options are available for eligible state residents, with salary in the 75k–78k range.

Qualifications

• 5+ years in a Pharmacy Benefit role
• Knowledge of health benefits carrier concepts and PBM operations
• Experience interpreting pharmacy claims and utilization data
• Strong communication and relationship management skills
• Ability to manage multiple priorities and detail orientation

Responsibilities

• Serve as the primary subjectmatter expert for pharmacy benefits and PBM system capabilities
• Interpret claims data, evaluate trends, and address issues
• Make decisions regarding PBM operational needs and performance-monitoring processes
• Collaborate with internal teams to develop educational materials
• Coordinate reporting and discussions with external customers and vendors
• Assist with risk management and system updates related to benefits
• Coordinate with PBM and vendors for QA, audit materials and reviews
• Quantify savings and outcomes for pharmacy programs
• Support QIC presentations with program analyses and performance reviews
• Other duties as assigned

Skills

Pharmacy benefits

Data interpretation

Analytical thinking

Stakeholder management

Communication

Education

High school diploma

Associate's degree

Tools

PBM claims system

Audit tools

Job description

WPS Health Solutions seeks a Pharmacy Coordinator to oversee audit processes for PBM activities and to build expertise in the PBM's online claims system. You will assist internal teams and resolve escalated customer issues.

The role requires 5+ years in a Pharmacy Benefit setting, strong data interpretation skills, and collaboration across departments. Remote and hybrid options are available for eligible state residents, with salary in the 75k–78k range.