Senior PBM & TPA Solutions Architect

Personify Health, Inc.; Tempe (AZ); On-site; USD 85,000 - 118,000; Full time

Benefits offered by this job

Competitive base salary

Job summary

Personify Health, Inc. is seeking an experienced PBM/TPA architect to design end-to-end workflows across eligibility, claims, billing, and benefit administration. You’ll translate complex requirements into production-ready solutions with cross-functional teams in Claims, Implementation, and Tech Ops.

You will own PBM solution design, negotiate data standards, and drive partnerships with PBMs and vendors while shaping product offerings and building internal expertise to improve client outcomes.

Qualifications

• 7+ years of experience in healthcare, TPA operations, product, systems architecture, implementation, or related fields
• Background in PBM operations, data file formats, data dictionaries, and compliance requirements
• Experience with pharmaceutical rebate structures, formulary management, and drug cost containment strategies
• Working knowledge of legal and regulatory requirements governing PBM operations and data sharing (HIPAA, CMS, etc.)
• Track record mapping complex processes and building end-to-end workflow designs
• Data management systems and analytics tooling
• PBM data file formats and data exchange standards
• Rebate and pricing agreement structures
• Process documentation and SOP development tools

Responsibilities

• Architect end-to-end TPA solutions across eligibility, claims, billing, and benefits
• Translate complexity into executable cross-functional workflows
• Own PBM solution design and future-state data flows
• Negotiate data standards and SLAs for PBM operations
• Manage PBM partnerships and vendor onboarding end-to-end
• Shape PBM product offerings with PBMs
• Build training materials for PBM landscape and operations
• Track drug cost containment and vendor savings opportunities
• Manage pricing and rebates negotiations
• Provide leadership with program performance insights

Job description

Personify Health, Inc. is seeking an experienced PBM/TPA architect to design end-to-end workflows across eligibility, claims, billing, and benefit administration. You’ll translate complex requirements into production-ready solutions with cross-functional teams in Claims, Implementation, and Tech Ops.

You will own PBM solution design, negotiate data standards, and drive partnerships with PBMs and vendors while shaping product offerings and building internal expertise to improve client outcomes.