Senior Pharmacy Ops Specialist - Remote

Mass General Brigham Health Plan, Inc.; Somerville (MA); Remote; USD 64,000 - 93,000; Full time

Benefits offered by this job

Remote work eligibility

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Senior Pharmacy Operations Specialist to lead the administration and improvement of the pharmacy benefit for Commercial and Medicaid members within a large integrated healthcare system.

The role combines operations, analytics, vendor oversight, and project leadership to ensure compliant, efficient benefit configurations across PBM partners and internal teams.

Qualifications

• 5-7 years of pharmacy benefit, managed care, PBM, health plan, pharmacy operations, or related healthcare experience.
• 3-5 years of experience working with pharmacy claims, benefit configuration, formulary, utilization management, or PBM operations.

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 benefits operations

Data analytics

SQL

Excel

Project management

Education

Bachelor's degree in related field

Tools

SQL

MS Excel

Reporting tools

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Senior Pharmacy Operations Specialist to lead the administration and improvement of the pharmacy benefit for Commercial and Medicaid members within a large integrated healthcare system.

The role combines operations, analytics, vendor oversight, and project leadership to ensure compliant, efficient benefit configurations across PBM partners and internal teams.