Remote PBM Operations Leader — Data-Driven & Scalable

EmpiRx Health; United States; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Vision coverage

Student Loan Reimbursement

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health is seeking a PBM Operations Team Lead to manage a multi-disciplinary team overseeing eligibility, accumulators, and claims adjudication for a designated client book. This role ensures data integrity, timely issue resolution, and scalable processes across PBM systems.

The Lead collaborates with IT, Data Engineering, Client Management, and TPAs to optimize service delivery, drive continuous improvement, and support growth. Remote work options are available.

Qualifications

• Bachelor’s degree in business, healthcare administration, or related field (or 5+ years healthcare with increasing responsibility).
• Minimum 2 years in healthcare eligibility, accumulators, and claims, or related field.
• Minimum 1 year of leadership, supervisory, or team lead experience.
• Strong knowledge of eligibility & accumulator management, benefit configuration, and claims adjudication.
• Experience managing operational escalations and cross-functional initiatives.
• Experience with healthcare compliance requirements (HIPAA, PHI, PII).

Responsibilities

• Lead a multi-disciplinary team of analysts ensuring timely issue resolution, data accuracy, and operational efficiency across eligibility, accumulator, and claims adjudication functions.
• Serve as SME for PBM platforms, eligibility, accumulator management, and claims adjudication per plan design.
• Monitor daily performance metrics and implement process improvements for efficiency and scalability.
• Ensure activities align with contractual requirements, service levels, and quality standards.
• Support rapid issue resolution, mitigation, and operational decision-making.
• Drive root-cause analysis and corrective action planning for recurring issues.
• Support configuration requirements and user acceptance testing for client implementations and plan changes.

Skills

Leadership

Analytical

Communication

Stakeholder management

Problem solving

Education

Bachelor’s degree or equivalent in related field

Tools

Azure Databricks

Job description

EmpiRx Health is seeking a PBM Operations Team Lead to manage a multi-disciplinary team overseeing eligibility, accumulators, and claims adjudication for a designated client book. This role ensures data integrity, timely issue resolution, and scalable processes across PBM systems.

The Lead collaborates with IT, Data Engineering, Client Management, and TPAs to optimize service delivery, drive continuous improvement, and support growth. Remote work options are available.