Operations & Implementations Specialist (PBM) at Advanced Medical Pricing Solutions

Phoenix, Arizona, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Jun, 26

Salary

0.0

Posted On

12 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Benefit Configuration, Client Onboarding, QA, Testing, Plan Audits, Claims Review, Task Prioritization, Client Setup, TPA Transitions, Document Preparation, Portal Updates, Billing Setup, Time Management, Client-Facing Interactions, Microsoft Office, Adjudication Systems

Industry

Insurance

Description

Description We are seeking a detail-oriented and personable Operations & Implementations Specialist to join our Pharmacy Benefit Management (PBM) team. This hybrid role bridges two critical functions—Operations and Implementations—ensuring accurate benefit configuration and smooth client onboarding. If you thrive in a fast-paced environment and enjoy both technical work and client interaction, this position is for you. You will accomplish this through: Requirements Essential Job Duties: Operations (First half to three-quarters of the year): Configure pharmacy benefit plan rules in our adjudication engine and portal tools. Perform QA, testing, and plan audits for new implementations and mid-year changes. Review claims for new groups/plans during the initial go-live month. Collaborate with Operations Analysts and Team Leads to prioritize and complete tasks. Implementations (Final quarter of the year): Assist the Implementation Manager with new client setups, plan changes, and TPA transitions. Communicate with clients, brokers, and TPAs to gather required information. Prepare and update plan documents, SBCs/SPDs, and maintain SharePoint resources. Update client portals with key attributes (fees, Section 111 data, etc.). Coordinate with Finance for billing setup and Account Management for advocacy and customizations. Skills and Abilities: Basic understanding of pharmacy benefits and operational logic (PBM experience preferred). Strong organizational and time management skills. Excellent communication skills—comfortable in client-facing interactions. Ability to manage multiple priorities in a fast-paced environment. Proficiency in Microsoft Office and familiarity with portals or adjudication systems Preferred Experience in PBM operations or healthcare implementations. Familiarity with SBC/SPD review and benefit configuration.

Responsibilities

This role involves configuring pharmacy benefit plan rules in the adjudication engine and performing quality assurance, testing, and plan audits for new implementations. The specialist will also assist with new client setups, plan changes, and TPA transitions by gathering information and updating necessary documentation and portals.