PBM Contract Operations Analyst

Job not on LinkedIn

🔥 50 minutes ago

🏈 Alabama, Arizona, +25 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote ⚜️ Louisiana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $60.2k - $72.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Understand plan formulary design and contracting potentials for client-specific setups • Analyze claims data to ensure contract-processing accuracy and establish client recommendations for contract optimization • Provide sales and RFP support for prospective clients, renewals, and market checks • Collaborate with Finance and Underwriting to evaluate contracts and manage pricing risk • Support contract review, data entry, evaluation, and reconciliation of client contract financial guarantees • Facilitate delivery of information for business decision-making • Serve as direct contact for Client Services on contract reporting, guarantee questions, and data analysis • Coordinate with Analytics on contract reporting environments • Assist with new contract program initiatives and contract forecasting expansion • Serve as subject matter expert for internal, external, manufacturer, client, and regulatory audits • Lead and coordinate government-related or regulated reporting • Review discount strategy and pharmaceutical manufacturer contracts, maintain contract-processing parameters, and allocate payments • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree required • 3-5 years of managed care/pharmacy benefits management or pharmaceutical experience required • Pharmacy technician license preferred • Pharmacy technician, trade, Industry Relations, and/or analytical experience preferred • Experience with PBMs and rebate analytics • Ability to understand plan formulary design and contracting potentials • Ability to analyze claims data • Ability to support contract review, data entry, evaluation, and reconciliation • Ability to participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750! • Remote work for residents of specified U.S. states