Pharmacy Benefits Auditor & PBM Systems Expert

WPS Health Solutions; Charlotte (NC); 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 full match for first 3%

Paid time off

Health, dental, telehealth start Day 1

Leadership development programs

Job summary

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and to develop expertise in the PBM’s online claims system. The role serves as a knowledgeable resource for Health Services and other internal teams to resolve escalated customer issues.

The position offers remote/hybrid options, a salary of 75–78k, benefits starting Day 1, and requires 5+ years in a Pharmacy Benefit role with strong analytical and communication skills.

Qualifications

• High school diploma and work-related experience.
• Associate's degree in business, healthcare, or related field preferred.

Responsibilities

• Serve as primary subjectmatter expert for pharmacy benefits and system capabilities, guiding internal teams and resolving escalated customer issues.
• Interpret pharmacy claims and utilization data, evaluate trends, and determine actions to address performance gaps.
• Make decisions regarding PBM operational needs and maintain performance-monitoring processes with PBM.
• 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 to evaluate high-cost claims and actions for denials.
• Assist Plan Product with mask configuration and system research, partnering with PBM on updates.
• Coordinate with PBM and vendors for materials for QIC presentations and program reviews.
• Quantify savings and outcomes for pharmacy programs and identify cost-reduction opportunities.
• Other duties as assigned

Education

High school diploma

Associate's degree preferred

Tools

PBM claims system

Health benefits knowledge

Job description

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and to develop expertise in the PBM’s online claims system. The role serves as a knowledgeable resource for Health Services and other internal teams to resolve escalated customer issues.

The position offers remote/hybrid options, a salary of 75–78k, benefits starting Day 1, and requires 5+ years in a Pharmacy Benefit role with strong analytical and communication skills.