Remote Pharmacy Benefits Analyst & Audit Specialist

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

Benefits offered by this job

Remote options

Hybrid work 2 days/week

401(k) match

Health insurance

Dental insurance

Telehealth

Professional development

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 online claims system, guiding internal teams to resolve escalated customer issues.

The role collaborates with the Health Services Contract Center and other internal teams, interprets pharmacy claims data, and determines actions to improve performance and cost efficiency while partnering with PBM and vendors on audit requirements.

Qualifications

• High school diploma and work-related experience.
• 5+ 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 basic utilization review workflows.
• Excellent communication and strong relationship management with internal and external partners.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to manage multiple priorities.

Responsibilities

• Serve as primary SME for internal teams on pharmacy benefits and PBM system capabilities.
• Interpret pharmacy claims and utilization data to identify trends and determine actions.
• Make decisions regarding PBM operational needs and vendor performance management.
• Collaborate with Call Center, Sales, Account Management, Marketing and Health Services.
• Coordinate PBM employer group reporting and support external customer discussions.
• Work with Risk Management on high-cost claims and denials decisions.
• Coordinate with PBM on benefit or system updates and presentations for QIC.

Skills

Pharmacy benefits knowledge

Analytical skills

Communication skills

Relationship management

Education

High school diploma

Associate’s degree

Job description

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 online claims system, guiding internal teams to resolve escalated customer issues.

The role collaborates with the Health Services Contract Center and other internal teams, interprets pharmacy claims data, and determines actions to improve performance and cost efficiency while partnering with PBM and vendors on audit requirements.