Principal PBM Data Integration Lead

🔥 18 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $148k - $205k / year

⏰ Full Time

🟠 Senior

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Prescryptive Health, Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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.

📋 Description

• Profile, map, and validate complex claims, eligibility, accumulator, and encounter data across multiple sources. • Resolve daily eligibility and accumulator discrepancies arising from file imports and monthly reconciliations. • Write and execute advanced SQL for investigation, validation, regression testing, and special data loads. • Lead cross-functional root-cause investigation and remediation of production issues. • Anticipate system and data failures before they happen. • Partner with engineering and architects on scalable, compliant integration architecture for claims, eligibility, and accumulators. • Own end-to-end delivery of benefit data integrations, including timelines, milestones, risks, dependencies, and executive reporting. • Coordinate with external vendors and internal engineering, translating vendor data formats and constraints for engineering and vice versa. • Plan and coordinate integration testing, UAT, and implementation readiness, including data migration, rollback planning, and post-deployment support. • Communicate findings and recommendations to technical and non-technical stakeholders. • Maintain system documentation and operational procedures. • Direct teams handling day-to-day integration work.

🎯 Requirements

• Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative field. • At least 10 years of hands-on technical experience with data systems, SQL, and integrations. • At least 6 years of direct PBM or pharmacy claims processing experience, including deep knowledge of benefit configuration, adjudication logic, eligibility, and accumulator integrations. • Advanced SQL proficiency, including complex querying and data investigation. • Experience supporting eligibility and accumulator reconciliation processes. • Experience designing scalable data architecture for healthcare data systems. • Experience managing delivery timelines, risks, and dependencies, and coordinating integration testing and UAT. • Working knowledge of the ANSI/NCPDP Telecommunication Standard and PBM or TPA claims processing. • Hands-on experience with ETL, secure file transfer (SFTP/PGP), and job scheduling and alerting tools. • Experience with a pharmacy benefits adjudication platform. • Cloud experience, ideally Microsoft Azure, in healthcare data environments. • Familiarity with C#, Java, JavaScript, Python, or R.

🏖️ Benefits

• The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry. • Flexible time off, including 12 paid holidays. • 401k match plus 100% employer-provided medical, dental, and vision premiums. • Company contribution to Health Savings Account. • Stock options.