Formulary Operations Analyst

Job not on LinkedIn

🕒 May 29

🇺🇸 United States – Remote

💵 $75k - $85k / year

⏰ Full Time

🟢 Junior

⚙️ Operations

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RxSense

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

💰 Private Equity Round on 2020-05

Healthcare Insurance • Pharmaceuticals • SaaS

RxSense is a HealthTech company dedicated to modernizing pharmacy benefit management. They develop cutting-edge products that optimize claims adjudication and analysis, aiming to lower costs and improve access within the pharmacy ecosystem. RxSense offers solutions for PBMs, pharmacies, pharma manufacturers, payers, and consumers, supporting better outcomes for millions of people daily. Their products include advanced tools like the RxIQ Enterprise adjudication engine, business intelligence analytics platform, and AI-based pricing optimization. They are known for their flagship prescription savings brand, SingleCare, which helps consumers secure affordable prices while benefiting pharmacy partners.

📋 Description

• Configure, update, and maintain custom and standard formularies within the claims adjudication system. • Ensure accuracy and alignment of formulary builds with client intent, clinical strategy, and regulatory requirements. • Troubleshoot adjudication issues and discrepancies; conduct detailed analysis to resolve defects and anomalies. • Participate in client implementations by gathering and documenting formulary requirements. • Serve as a clinical capabilities subject matter expert. • Collaborate with internal teams to ensure smooth integration of formulary solutions. • Perform audits to validate formulary configuration accuracy. • Monitor claim processing to detect and correct potential issues proactively. • Assist in analyzing and presenting data related to formulary performance or disruptions. • Pull, organize, and aggregate data and reports to support client meetings and formulary strategy presentations. • Support client interactions as needed, including responding to formulary-related inquiries and assisting in training sessions. • Work closely with clinical partners to ensure translation of clinical direction into accurate system configuration. • Contribute to development and documentation of internal workflows, best practices, and training materials. • Lead or contribute to special initiatives such as process optimization, disruption analyses, or platform enhancements. • Recommend and implement improvements to ensure greater accuracy, efficiency, and scalability of formulary operations.

🎯 Requirements

• Bachelor’s degree or 1 year equivalent experience in healthcare (PBM) • 1+ year's of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics. • Demonstrated expertise in configuring and maintaining formulary data within claims systems. • Excellent working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations. • Strong problem-solving skills with the ability to analyze data and translate findings into actionable solutions. • Detail-oriented, with the ability to manage multiple priorities and meet deadlines. • Superior written and verbal communication skills — clear and concise with both internal and client-facing audiences. • Excellent organizational and time management skills. • Ability to take the lead on projects and follow through to completion. • Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data. • Self-starter with a proactive mindset and a high level of accountability.