PBM Operations Specialist

Job Description

Waltz Health is looking for a thoughtful, detail-oriented, organized, passionate, and creative PBM Operations Specialist who can both understand the strategic vision of our company and apply that understanding to help improve the healthcare experience and outcomes of patients. This individual will assist with the implementation and maintenance of pharmacy adjudication plans. Specifically supporting the Waltz Connect Product, with a focus on the Specialty and GLP-1 opportunities as well as our ISP Integrated Savings Programs. Deep curiosity and a desire to learn along with industry and functional experience will be critical to success in this role. As a Waltz PBM Operations Specialist, you will partner with business stakeholders and clients to understand the voice of the customer and translate that information into fully functional, high-quality pharmacy adjudication plans. The successful PBM Operations Specialist will play an essential part in the implementation and maintenance of plans supporting key clients and partners. The ideal candidate for this role will be able to combine a strong analytical and technical mindset with the ability to translate requirements into functional plan designs.

In this important role, you will collaborate with our entire team, including our Product Team, VP and SVP of Product, Chief Strategy Officer, and Chief Technology Officer. 

This role reports to our Vice President, Pharmacy Product Management.  You will primarily focused on the following responsibilities:

• Research, develop, test, evaluate, and document plan and benefit design
• Monitor and analyze data and procedures for claims processing
• Identify opportunities for improvement and develop new benefit reporting capabilities
• Serve as a benefit subject matter expert
• Research and resolve claims processing requests
• Review release notes for potential enhancements to configuration or plan capabilities
• Configuring new features
• Developing and providing expertise on the pharmacy industry, the pain points, and the opportunities to create value.
• Using industry expertise to drive plan strategy and improve the lives of our patients and end users.
• Create broad documentation in support of the Waltz plan portfolio, capturing strategic business details as well as detailed technical materials.
• Create, maintain, and socialize internal and external plan design.
• Incorporate feedback from internal and external customers on product strategy and use the voice of the patient to expand and drive market reach

In the first 90 days you, will:

• Develop implementation and plan maintenance process
• Hear and understand the voice of the customer.  Gain a deep understanding of Waltz clients and users, identify both internal and external customers, develop relationships and document needs and identify opportunities.
• Develop an understanding of existing product processes and artifacts; identify the problem and solution spaces to explore with product strategy.
• Immerse yourself in the landscape.  Identify the problem and solution spaces to explore with product strategy.
• Understand product quality and baseline metrics.  Identify opportunity to drive the quality of our upcoming software releases.

You will be successful because you have these traits and skills:

• PBM Pharmacy Benefit Management Experience; understanding clients, benefit plans, formulary management, prior authorization, claim request and response
• Pharmacy Benefit experience
• Specialty Pharmacy experience, Retail Pharmacy experience, PBM Pharmacy Benefit Management experience; understanding clients, benefit plans, formulary management, prior authorization, claim request and response
• Task Management/Prioritization
• Quality Assurance/Software Testing experience
• Backlog Management
• Requirements Gathering and Documentation, Ability to understand and capture stakeholder-driven business requirements and translate those to plan requirements
• Stakeholder management and communication
• Microsoft Office (All, with deep proficiency in PowerPoint)

We'd love for you to have these qualifications:

• Bachelor's degree
• Master's degree (bonus)
• 2+ years PBM/Pharmacy/Specialty or Mail Order pharmacy experience
• 2-3 years of Product management experience
• 1-2 years Implementation/Integration experience

Pay Range

$60k - $80k Annual salary