PBM Analyst

October 17

🐊 Florida – Remote

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

💵 $70k - $100k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🦅 H1B Visa Sponsor

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Rightway

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Healthcare Insurance • SaaS • B2B

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $100M Series C on 2021-03

📋 Description

• Execute financial and pricing models for client bids and renewals, interpreting results to identify key cost and performance drivers. • Present underwriting analyses to internal stakeholders and refine offers to achieve optimal competitiveness. • Perform detailed pharmacy claims analysis to identify and remedy variances in financial performance by recommending adjustments to pricing schedules. • Conduct studies on novel pricing phenomena and industry trends to support market-leading innovative pricing strategies. • Prepare and process client invoices, remittances, and billing files with accuracy and timeliness. • Analyze pharmacy claims and administrative fee data to identify trends and ensure compliance with contractual terms. • Interpret client contracts to extract billing requirements and flag variances impacting operational accuracy. • Collaborate with Finance, Legal, and Operations teams to streamline billing processes and resolve discrepancies. • Analyze pharmacy claims and rebate data to identify cost drivers, trends, and performance variances. • Evaluate client-level rebate guarantees and forecasting models to support underwriting and renewals. • Partner with Clinical and Formulary teams to assess the financial impact of formulary decisions and new drug launches. • Support audit and internal control documentation, ensuring rebate data accuracy and transparency. • Build and deliver PBM pricing analytics, such as copay modeling, formulary impact reports, and executive dashboards. • Conduct studies on industry trends and regulatory changes to inform innovative pricing and market strategies. • Maintain and validate critical datasets including drug lists, network data, and rebate or pricing structures. • Participate in process improvement initiatives to enhance scalability, efficiency, and data integrity.

🎯 Requirements

• Bachelor's degree in Business, Finance, Mathematics, Accounting, or related field • 1-2 years of relevant experience in billing, finance underwriting, or data analysis • Strong proficiency in Microsoft Excel, including formulas, pivot tables, and data manipulation • SQL or Python programming knowledge and experience • Excellent attention to detail and accuracy in data entry and analysis • Strong written and verbal communication skills • Ability to read and interpret contracts and legal documents • Experience with database management systems preferred

🏖️ Benefits

• Health insurance • 401(k) • Paid time off • Flexible work arrangements • Professional development opportunities