Pharmacy Benefits Operations Lead (Hybrid)

WPS—A health solutions company; Virginia (MN); 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/dental/telehealth start day 1

Leadership development programs

Job summary

WPS, a health solutions company, is seeking a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and to develop expertise in the PBM online claims system. You will serve as a knowledgeable resource for the Health Services Contract Center and other internal teams to resolve escalated customer issues.

The role expects 5+ years in a Pharmacy Benefit role, strong analytical skills, and the ability to interpret pharmacy trends, manage vendor relationships, and support

Qualifications

• 5+ years in a Pharmacy Benefit role within health insurers, PBMs, or equivalent.
• Knowledge of health benefits carrier concepts and PBM operations and terminology.
• Understanding of pharmacy claims processing and formulary management.
• Excellent communication and relationship management with internal and external partners.
• Strong analytical and problem-solving skills with attention to detail and ability to manage multiple priorities.
• Associate’s degree in business, healthcare, or related field is preferred.

Responsibilities

• Serve as SME for internal teams on pharmacy benefits and PBM capabilities.
• Interpret claims data, evaluate trends, and address performance gaps.
• Decide PBM operational needs and partner with PBM to maintain monitoring processes.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services.
• Coordinate PBM employer group reporting and support external discussions.
• Work with Risk Management to evaluate high-cost claims and denials.
• Assist Plan Product with PBM updates and system configurations.
• Coordinate with PBM and vendors for QIC presentations.
• Quantify savings and outcomes for pharmacy programs.

Skills

PBM knowledge

Regulatory knowledge

Pharmacy claims processing

Utilization review

Analytical skills

Communication skills

Attention to detail

Multitasking

Education

High school diploma

Associate’s degree in business or healthcare

Job description

WPS, a health solutions company, is seeking a Pharmacy Coordinator to oversee audit processes for delegated PBM activities and to develop expertise in the PBM online claims system. You will serve as a knowledgeable resource for the Health Services Contract Center and other internal teams to resolve escalated customer issues.

The role expects 5+ years in a Pharmacy Benefit role, strong analytical skills, and the ability to interpret pharmacy trends, manage vendor relationships, and support