Pharmacy Benefits & Vendor Liaison (Hybrid/Remote)

WPS—A health solutions company; Minnesota; Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) matching

Competitive PTO

Health/Dental/Telehealth start day 1

Job summary

WPS—A health solutions company is hiring a Pharmacy Coordinator to oversee development and execution of audit processes for PBM delegated activities. You will build expertise in the PBM claims system and guide internal teams to resolve escalated customer issues, interpreting claims data and trends to address performance gaps.

Hybrid role based near Madison, WI, with remote work in designated states. You will collaborate across departments to improve educational materials and PBM reporting while

Qualifications

• High school diploma and work-related experience.
• 5 or more years in a Pharmacy Benefit role, working for a Health Insurer, Pharmacy Benefit Manager, or equivalent
• Knowledge of health benefits insurance carrier concepts, pharmacy benefit management operations, terminology, and relevant regulatory standards (URAC, CMS, state).
• Understanding of pharmacy claims processing, formulary management, and basic utilization review workflows.
• Excellent communication and strong relationship management skills with internal and external partners.
• Strong analytical and problem-solving skills,
• Strong attention to detail skills, and ability to manage multiple priorities.

Responsibilities

• Serve as the primary subject‑matter expert for internal teams on pharmacy benefits and system capabilities, exercising independent judgment to guide internal teams and resolve highly complex or escalated customer issues.
• Interpret pharmacy claims and utilization data, evaluate trends, and determine appropriate actions to address emerging issues or performance gaps.
• Make decisions regarding PBM operational needs, partnering with PBM to maintain performance-monitoring processes, resolve discrepancies and manage escalating vendor concerns.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to enhance organizational, determining the most effective educational materials
• Coordinate PBM employer group reporting and support external customer discussions, interpreting pharmacy trends and benefit design to provide clear guidance and recommendations.
• Work with Risk Management to evaluate high-cost claims and determine actions for Short Term Health Plan denials.
• Assist Plan Product and related departments with mask configuration and system research, exercising judgment when deciding how to partner with the PBM on benefit or system updates.
• Coordinate with PBM and pharmacy vendors to gather and review materials for presentations to Quality Improvement Committee (QIC), including analyses of program performance, pharmacy policies, vendor performance, and audit requirements.
• Quantify savings and outcomes for pharmacy programs, evaluating results and determining opportunities for process improvements or cost reductions.
• Other duties as assigned

Skills

Communication skills

Relationship management

Analytical skills

Attention to detail

Multitasking

Education

High school diploma

5+ years in Pharmacy Benefit role

Job description

WPS—A health solutions company is hiring a Pharmacy Coordinator to oversee development and execution of audit processes for PBM delegated activities. You will build expertise in the PBM claims system and guide internal teams to resolve escalated customer issues, interpreting claims data and trends to address performance gaps.

Hybrid role based near Madison, WI, with remote work in designated states. You will collaborate across departments to improve educational materials and PBM reporting while