Remote Pharmacy Benefits Coordinator & PBM Liaison

WPS; Madison (WI); Hybrid; USD 75,000 - 78,000; Full time

Benefits offered by this job

Remote/Hybrid options

Performance bonus

401(k) with employer match

Competitive PTO

Health insurance from Day 1

Job summary

WPS Health Solutions, headquartered in Madison, WI, seeks a Pharmacy Coordinator to oversee audit processes, develop PBM system expertise, and guide internal teams in resolving escalated customer issues. The role requires strong analytics and cross-functional collaboration.

You will interpret claims, monitor performance, and coordinate with PBM and vendors on program outcomes, while supporting risk management and cost-reduction initiatives.

Qualifications

• High school diploma plus work-related experience.
• 5+ years in a Pharmacy Benefit role for insurer, PBM, or equivalent.
• Knowledge of health benefits, PBM operations, terminology and regulatory standards.
• Understanding of pharmacy claims processing and formulary management.
• Strong communication and relationship management with internal and external partners.
• Analytical, problem-solving with attention to detail and multi-priority handling.

Responsibilities

• Serve as primary subject-matter expert for pharmacy benefits and system capabilities.
• Interpret pharmacy claims data, evaluate trends, and address issues.
• Make decisions on PBM operational needs and monitor performance.
• Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services.
• Coordinate PBM employer group reporting and external discussions.
• Support risk management for high-cost claims and denials.
• Coordinate with PBM and vendors for QIC presentations.
• Quantify savings and outcomes for pharmacy programs.
• Other duties as assigned.

Skills

PBM knowledge

Data analysis

Communication skills

Relationship management

Problem solving

Attention to detail

Education

High school diploma

Associate's degree in business/healthcare

Job description

WPS Health Solutions, headquartered in Madison, WI, seeks a Pharmacy Coordinator to oversee audit processes, develop PBM system expertise, and guide internal teams in resolving escalated customer issues. The role requires strong analytics and cross-functional collaboration.

You will interpret claims, monitor performance, and coordinate with PBM and vendors on program outcomes, while supporting risk management and cost-reduction initiatives.