Pharmacy Benefits Lead — Hybrid/Remote Options

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

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) with match

Competitive PTO

Health insurance starts Day 1

Professional development

Job summary

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

The role requires 5+ years in pharmacy benefits and strong analytical, communication, and stakeholder management skills. The position offers hybrid work with optional remote arrangements subject to policy.

Qualifications

• 5+ years in a Pharmacy Benefit role, working for a Health Insurer, PBM, or equivalent.
• Knowledge of health benefits insurance carrier concepts, PBM operations, terminology, and relevant regulatory standards (URAC, CMS, state).
• Understanding of pharmacy claims processing, formulary management, and basic utilization review workflows.
• Excellent communication and strong relationship management skills with internal and external partners.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to manage multiple priorities.

Responsibilities

• Serve as primary subject‑matter expert for internal teams on pharmacy benefits and system capabilities, guiding actions on escalated issues.
• Interpret pharmacy claims and utilization data, evaluate trends, and address performance gaps.
• Decide PBM operational needs and collaborate with PBM to maintain performance-monitoring processes.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to create effective educational materials.
• Coordinate PBM employer group reporting and support external customer discussions with guidance on trends and benefit design.
• Work with Risk Management to evaluate high-cost claims and determine actions for denials.
• Assist Plan Product and related departments with mask configuration and PBM partnership on updates.
• Coordinate with PBM and vendors to prepare materials for Quality Improvement Committee reviews.

Skills

Pharmacy benefits experience

Analytical thinking

Communication skills

Education

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

Job description

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

The role requires 5+ years in pharmacy benefits and strong analytical, communication, and stakeholder management skills. The position offers hybrid work with optional remote arrangements subject to policy.