Senior Pharmacy Operations Lead - Data-Driven & Cross-Functional

massgeneralbrigham; Somerville (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to lead the administration, implementation, monitoring and continuous improvement of the pharmacy benefit for Commercial and Medicaid members within the Mass General Brigham system.

This senior role combines operational expertise with data analytics, vendor oversight, regulatory support, and cross-functional project leadership to deliver compliant, high-quality pharmacy benefits.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• 5-7 years of pharmacy benefit or related healthcare experience.
• 3-5 years with pharmacy claims, benefit configuration, formulary or PBM operations.
• Experience with data analytics tools, SQL, and reporting.
• Ability to lead cross-functional initiatives.

Responsibilities

• Ensure effective day-to-day administration of the pharmacy benefit across all lines of business.
• Research and resolve complex operational issues, identify root causes, and implement sustainable corrective solutions.
• Monitor pharmacy operational processes and identify and advance opportunities to improve efficiency, accuracy, and quality.
• Monitor PBM operational performance and hold vendors accountable for timely, accurate deliverables and service standards.
• Coordinate issue resolution, implementations, testing, and ongoing operational activities with the PBM and internal partners.
• Translate benefit and clinical requirements into operational specifications and validate formulary, utilization management, benefit, and claims configurations.
• Support compliance with applicable state, federal, contractual, and regulatory requirements, including audits, regulatory implementations, corrective action plans, and ongoing compliance monitoring for Commercial and Medicaid products.
• Analyze pharmacy claims and operational data to identify trends, anomalies, and opportunities, and develop reporting that supports operational and leadership decision-making.
• Lead cross-functional pharmacy initiatives from requirements through implementation, and serve as a subject matter expert and mentor who promotes consistent processes and operational standards across the Pharmacy Operations team.

Skills

Pharmacy benefit operations

Data analytics

SQL

Project management

Communication

Excel

Regulatory compliance

Education

Bachelor's degree in related field

Tools

Microsoft Office

Job description

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to lead the administration, implementation, monitoring and continuous improvement of the pharmacy benefit for Commercial and Medicaid members within the Mass General Brigham system.

This senior role combines operational expertise with data analytics, vendor oversight, regulatory support, and cross-functional project leadership to deliver compliant, high-quality pharmacy benefits.