Pharmacy Vendor Operations Lead (Hybrid/Remote)

WPS—A health solutions company; Colorado; Hybrid; USD 47,000 - 78,000; Full time

Benefits offered by this job

Remote and hybrid options

Performance bonus

401(k) match

Paid time off

Health and telehealth start day 1

Leadership development

Job summary

WPS, a health solutions company, is seeking a Pharmacy Coordinator to oversee audit processes for PBM-delivered activities and resolve escalated customer issues. The role builds expertise in the PBM claims system and supports Health Services and internal teams.

The senior candidate will interpret pharmacy claims data, monitor trends, and determine actions to improve performance and cost efficiency within a hybrid work arrangement near Madison, WI.

Qualifications

• High school diploma or equivalent required.
• 5+ years in a Pharmacy Benefit role within health insurers, PBMs, or equivalent.
• Knowledge of health benefits, PBM operations, terminology, and regulatory standards.
• Understanding of pharmacy claims processing, formulary management, and utilization review.
• Excellent communication and relationship management within internal and external partners.
• Strong analytical, problem-solving, and multitasking abilities.

Responsibilities

• Serve as SME for pharmacy benefits and system capabilities for internal teams.
• Interpret claims, evaluate trends, and address performance or escalation issues.
• Decide PBM operational needs and maintain performance-monitoring processes.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services.
• Coordinate PBM employer group reporting and support vendor discussions.
• Work with Risk Management on high-cost claims and denials decisions.
• Assist with mask configuration and PBM partnership on updates.
• Coordinate materials for Quality Improvement Committee reviews.
• Quantify savings and outcomes, identify cost-reduction opportunities.

Skills

Pharmacy benefit knowledge

Communication skills

Analytical skills

Attention to detail

Relationship management

Education

Associate degree

Job description

WPS, a health solutions company, is seeking a Pharmacy Coordinator to oversee audit processes for PBM-delivered activities and resolve escalated customer issues. The role builds expertise in the PBM claims system and supports Health Services and internal teams.

The senior candidate will interpret pharmacy claims data, monitor trends, and determine actions to improve performance and cost efficiency within a hybrid work arrangement near Madison, WI.