Pharmacy Benefits & PBM Audit Lead (Remote-Friendly)

WPS Health Solutions; Monona (WI); Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote & Hybrid options

Performance bonus/merit increase

401(k) with match

Job summary

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes for PBM delegated activities and to build expertise in the PBM's online claims system. You will guide internal teams through escalated issues and determine appropriate actions to resolve complex customer problems.

The role emphasizes interpreting claims data, addressing performance gaps, and partnering with PBM to maintain performance-monitoring processes, while supporting cross-functional teams across Health

Qualifications

• Knowledge of health benefits carrier concepts and PBM operations.
• Understanding of pharmacy claims processing, formulary management, and IRW workflows.
• Excellent communication and relationship management with internal and external partners.

Responsibilities

• Serve as SME for pharmacy benefits and system capabilities to internal teams.
• Interpret pharmacy claims data, identify trends, and address performance gaps.
• Collaborate with PBM and internal departments to resolve escalated issues and improve processes.
• Coordinate PBM employer group reporting and support external discussions.

Skills

Pharmacy benefits knowledge

Claims interpretation

Data analysis

Communication

Education

High school diploma

Associate's degree in business/healthcare

Job description

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes for PBM delegated activities and to build expertise in the PBM's online claims system. You will guide internal teams through escalated issues and determine appropriate actions to resolve complex customer problems.

The role emphasizes interpreting claims data, addressing performance gaps, and partnering with PBM to maintain performance-monitoring processes, while supporting cross-functional teams across Health