Pharmacy Benefits Auditor & Vendor Liaison (Remote)

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

Benefits offered by this job

Remote options

Hybrid options

Performance bonus

401(k) match

Paid time off

Health coverage

Job summary

WPS is seeking a Pharmacy Coordinator to oversee development and execution of audit processes for delegated PBM activities. You will build expertise in the PBM’s online claims system and serve as a resource for internal teams to resolve escalated customer issues.

The role involves interpreting pharmacy claims, evaluating trends, and partnering with PBM to maintain performance-monitoring processes. Hybrid work two days a week near Madison, WI, with remote options in approved states.

Qualifications

• 5+ years in a Pharmacy Benefit role within a health insurer, PBM, or equivalent.
• Knowledge of health benefits concepts, PBM operations, terminology, and regulatory standards (URAC, CMS, state).
• Understanding of pharmacy claims processing and formulary management.

Responsibilities

• Serve as the primary SME for pharmacy benefits and PBM capabilities for internal teams.
• Interpret pharmacy claims data, evaluate trends, and address issues or performance gaps.
• Coordinate PBM reporting and support external customer discussions on trends and design.

Skills

Analytical

Problem-solving

Communication

Relationship management

Attention to detail

Multitasking

Education

Associate’s degree in business, healthcare, or related field

High school diploma

Job description

WPS is seeking a Pharmacy Coordinator to oversee development and execution of audit processes for delegated PBM activities. You will build expertise in the PBM’s online claims system and serve as a resource for internal teams to resolve escalated customer issues.

The role involves interpreting pharmacy claims, evaluating trends, and partnering with PBM to maintain performance-monitoring processes. Hybrid work two days a week near Madison, WI, with remote options in approved states.