Pharmacy Vendor Coordinator

Wis Phys Svc Ins Corp; Madison (WI); Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

401(k) match

Performance bonus

Health insurance

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’s online claims system. You will support internal teams to resolve escalated customer issues and guide process improvements.

The role emphasizes interpretation of pharmacy claims data, trend evaluation, and collaboration with multiple departments. Hybrid work is available for employees near Madison, WI, with remote options to approved

Qualifications

• 5 or more years in a Pharmacy Benefit role for a Health Insurer, PBM, or equivalent.
• Knowledge of health benefits carrier concepts, PBM operations, terminology, and regulatory standards (URAC, CMS, state).
• Understanding of pharmacy claims processing, formulary management, and 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 and ability to manage multiple priorities.

Responsibilities

• Serve as the primary subject-matter expert for internal teams on pharmacy benefits and system capabilities.
• Interpret pharmacy claims and utilization data, evaluate trends, and address issues or performance gaps.
• Make decisions regarding PBM operational needs and partner with PBM to maintain monitoring processes and resolve vendor concerns.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to enhance educational materials.
• Coordinate PBM employer group reporting and support external customer discussions with clear guidance and recommendations.
• Work with Risk Management to evaluate high-cost claims and actions for denials.
• Assist Plan Product with mask configuration and system updates in partnership with PBM.
• Coordinate with PBM and vendors to gather materials for Quality Improvement Committee presentations.
• Quantify savings and outcomes for pharmacy programs and identify process improvements.

Skills

Excellent communication

Strong analytical

Attention to detail

Relationship management

PBM operations knowledge

Education

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

Job description

The Pharmacy Coordinator will oversee development and execution of audit processes that monitor delegated activities performed by the Pharmacy Benefits Manager (PBM). The role will build working expertise in the PBM’s online claims system and its capabilities, serving as a knowledgeable resource for the Health Services Contract Center and other internal teams to determine appropriate actions to resolve escalated customer issues. SalaryRange

75-78k, pay may fluctuate based on experience.

Work Location Employees within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713) will be expected to be able to be able to work Hybrid 2 days a week on a regular basis.

We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me?If youenjoy the following:

• 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

Minimum Qualifications

• 5ormore yearsin 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 basicutilizationreview 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.

Preferred Qualifications

• Associate’s degree in business, healthcare, or related field,

Remote Work Requirements

• High speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net ).
• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vestedimmediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs

WPS, a health solutions company, is a leading not‑for‑profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families,seniorsand group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-dutyand retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we servefor nearly 80 years . Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where thegreat workand innovations of our people are seen,fueledand rewarded. Weaccomplishthis by creating an open and empowering employee experience. We recognize the benefits ofemployee engagement as an investment in our workforce—both current and future—to effectivelyseek,leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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