Pharmacy Benefits Liaison & Audit Specialist (Hybrid/Remote)

WPS Health Solutions; Des Moines (IA); On-site; 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 vesting

Health, dental and telehealth start on

Professional and LeadershipDevelopment

Job summary

WPS Health Solutions seeks a Pharmacy Coordinator to oversee audit processes of delegated PBM activities and develop PBM system expertise to resolve escalated customer issues. The role supports internal teams with informed guidance on claims, trends, and performance gaps.

It offers remote/hybrid work options, competitive benefits, and growth within health insurance operations. The position requires 5+ years in a Pharmacy Benefit role and strong analytical skills.

Qualifications

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

Responsibilities

• Serve as the primary subjectmatter expert for internal teams on pharmacy benefits and system capabilities.
• Interpret pharmacy claims and utilization data, evaluate trends, and address issues or performance gaps.
• Make decisions regarding PBM operational needs and maintain performance-monitoring processes.
• Collaborate with Call Center, Sales, Account Management, Marketing and Health Services to enhance education materials.
• Coordinate PBM employer group reporting and support external customer discussions.
• Work with Risk Management to evaluate high-cost claims and determine actions for Short Term Health Plan denials.
• Assist Plan Product with mask configuration and system research, partnering with PBM on updates.
• Coordinate with PBM and pharmacy vendors to prepare materials for QIC presentations.
• Quantify savings and outcomes for pharmacy programs and identify cost-reduction opportunities.
• Other duties as assigned

Skills

Pharmacy benefits

Analytical skills

Communication

Relationship management

Regulatory knowledge

Education

High school diploma

Associate's degree

Job description

WPS Health Solutions seeks a Pharmacy Coordinator to oversee audit processes of delegated PBM activities and develop PBM system expertise to resolve escalated customer issues. The role supports internal teams with informed guidance on claims, trends, and performance gaps.

It offers remote/hybrid work options, competitive benefits, and growth within health insurance operations. The position requires 5+ years in a Pharmacy Benefit role and strong analytical skills.