Pharmacy Benefits Specialist - Hybrid/Remote Expert

WPS Health Solutions; Columbus (OH); Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) with matching

Paid time off

Health and dental insurance

Professional development programs

Job summary

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes of PBM delegated activities, interpret claims data, and support internal teams in resolving escalated customer issues. You will build expertise in the PBM's online system and guide colleagues on performance monitoring and risk decisions.

This role blends analytics with collaboration across Call Center, Sales, Account Management, Marketing and Health Services; you will prepare employer group reporting and

Qualifications

• 5+ years in a Pharmacy Benefit role for a health insurer, PBM, or equivalent.
• Knowledge of health benefits insurance concepts and regulatory standards.
• Understanding of claims processing, formulary management, and utilization review.
• Excellent communication and relationship management skills.

Responsibilities

• Serve as subjectmatter expert for pharmacy benefits and system capabilities.
• Interpret claims data, evaluate trends, and address performance gaps.
• Decide PBM operational needs and maintain performance-monitoring processes.
• Collaborate with Call Center, Sales, Account Management, Marketing and Health Services.
• Coordinate employer group reporting and support external discussions.
• Quantify savings and outcomes for pharmacy programs and identify improvements.

Skills

Pharmacy benefits knowledge

Auditing & compliance

Data interpretation

Communication & collaboration

Education

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

Tools

PBM software

Job description

WPS Health Solutions is seeking a Pharmacy Coordinator to oversee audit processes of PBM delegated activities, interpret claims data, and support internal teams in resolving escalated customer issues. You will build expertise in the PBM's online system and guide colleagues on performance monitoring and risk decisions.

This role blends analytics with collaboration across Call Center, Sales, Account Management, Marketing and Health Services; you will prepare employer group reporting and