Pharmacy Benefits Operations & Audit Specialist

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

Benefits offered by this job

Remote and hybrid options

Performance bonus

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth

Leadership development

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 online claims system, guiding internal teams to resolve escalated customer issues.

You will work with Health Services and other departments to interpret pharmacy claims, monitor performance, and support insights for cost reductions. Remote and hybrid options are available for this role.

Qualifications

• High school diploma with work experience in a pharmacy benefit role or related field.
• Knowledge of health benefits, PBM operations, and regulatory standards (URAC, CMS, state).
• Understanding of pharmacy claims processing and utilization review workflows.

Responsibilities

• Serve as subject-matter expert for internal teams on pharmacy benefits and PBM capabilities.
• Interpret claims data, evaluate trends, and address issues or performance gaps.
• Make decisions on PBM operational needs and maintain performance-monitoring processes.

Skills

Pharmacy benefits knowledge

Data analysis

Communication

Problem-solving

Relationship management

Prioritization

Education

High school diploma

Associate's degree (preferred)

Tools

PBM claims system

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 online claims system, guiding internal teams to resolve escalated customer issues.

You will work with Health Services and other departments to interpret pharmacy claims, monitor performance, and support insights for cost reductions. Remote and hybrid options are available for this role.