Senior Director, Benefit Operations

October 27

⚔️ Virginia – Remote

Although this job is listed in Virginia, this company may be open to hiring remote in other states.

☕ Washington – Remote

Although this job is listed in Washington, this company may be open to hiring remote in other states.

+3 more states

⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $175k - $240k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Prescryptive Health, Inc.

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Healthcare Insurance • SaaS • B2B

Prescryptive Health, Inc. is a healthcare technology company that operates the myPrescryptive platform to help patients, pharmacies, employers, health systems, and pharma manufacturers manage and optimize prescription medications. Its SaaS platform provides real-time patient alerts, digital prescription management (no app required), EHR integration, and AI-driven pricing tools to improve medication adherence, transparency, affordability, and pharmacy profitability. Prescryptive offers employer-facing benefit solutions (emPBM), pharmacy pricing optimization, and consumer-facing tools to compare prices and track medication spend, with security certifications such as HITRUST.

201 - 500 employees

Founded 2017

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

📋 Description

• Own and evolve the operating model for plan administration, claims adjudication, operational program governance, and regulatory execution. • Maintain flawless operational regulatory compliance with PBM, state, and federal requirements in partnership with Enterprise Compliance and Legal. • Optimize vendor ecosystem performance through clear SLAs, accountability, and cost management. • Drive operational modernization and intelligent automation to enhance accuracy, efficiency, and scalability. • Build capability, bench strength, and a culture of accountability and continuous improvement. • Provide executive oversight and accountability for all claims systems and adjudication processes managed by directors and managers, ensuring data integrity, accuracy, and operational regulatory compliance across all tiers. • Ensure end-to-end claims integrity and plan accuracy: adjudication platform performance, plan configuration accuracy, eligibility management, accumulator integrity, formulary structures, and data exchange with TPAs and other third parties. • Oversee formulary operations, plan design builds, pharmacy network operations, drug lists, and other plan-designated details to ensure accuracy, compliance, and alignment with benefit requirements and partner expectations. • Lead enterprise audit readiness with zero major findings; ensure timely, accurate responses to operational audits and regulator inquiries. • Partner with Enterprise Compliance and Legal to interpret new regulatory guidance and operationalize it effectively within systems and processes. • Sponsor complex migrations and implementations (platform, data, vendor) with on-time, in-scope delivery and measurable business outcomes. • Oversee the vendor ecosystem, setting SLAs, driving accountability, and optimizing cost and value across all contracts. • Define and execute a multi-year operational strategy with clear cost, quality, and service targets; report progress through executive-ready dashboards. • Identify single points of failure and build bench strength, succession plans, and cross-training to reduce risk. • Develop, maintain, and enforce Standard Operating Procedures (SOPs), QA programs, training curricula, and policies that ensure compliant, consistent operations across teams and partners. • Leverage AI and intelligent automation to streamline workflows, reduce manual effort, and elevate accuracy and speed across functions. • Establish and own core KPIs: first-pass adjudication accuracy, plan design accuracy, rework/adjustment rates, audit findings, cycle time, cost-to-serve, and stakeholder satisfaction. • Lead cross-functional initiatives with Clinical, Technology, Product, Finance, and Compliance to resolve root causes and improve outcomes.

🎯 Requirements

• Proven success providing strategic leadership in dynamic, high-growth environments with evolving priorities. • Track record aligning cost, compliance, and member experience to deliver measurable operational improvements. • Proven people leadership, including multi-level team supervision, management of a remote workforce, success developing others, and a practice of proactive performance management. • Expertise managing vendor ecosystems and leading complex negotiations to drive performance and value. • Executive presence with exceptional communication skills for internal leadership, clients, and industry partners. • History of leading continuous-improvement programs that enhance efficiency, quality, and risk mitigation. • Deep understanding of PBM operations and claim adjudication platforms (e.g., Rx adjudication systems, eligibility, accumulators, data exchange). • Ability to interpret and apply regulatory guidance, including ERISA, federal statutes, and state-based requirements. • Proficiency with Microsoft Word, Excel, PowerPoint, and Teams for reporting and collaboration. • Strong written and verbal communication skills with the ability to engage diverse audiences at all levels. • Experience leading AI-enabled automation or workflow initiatives that demonstrably improved quality, cost, or compliance is required. • Bachelor’s degree in healthcare, business, or related field. • 10+ years PBM/health plan operations leadership.

🏖️ Benefits

• Flexible time off, including 12 paid holidays • 401k match plus 100% employer paid medical, dental, and vision premiums • Company contribution to Health Savings Account • Stock options