PBM Operations Associate

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $70k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

💰 $100M Series C on 2021-03

Healthcare • Healthcare Insurance • SaaS

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.

📋 Description

• Support cross-functional projects across PBM operations, including go-live management and other strategic initiatives • Assist with client and plan implementations, coordinating across teams to help ensure accurate benefit setup, testing, and a smooth go-live • Provide pre- and post-audit support, managing deliverables and tracking to ensure timely, accurate completion • Coordinate Ops involvement across internal projects that require operational input or support • Track project timelines, deliverables, and action items, flagging risks or delays as they arise • Maintain clear, organized documentation, including SOPs and process trackers, to support visibility across projects and teams • Partner with cross-functional stakeholders, including Clinical, Client Services, IT, and Compliance, to help ensure operational readiness for new initiatives and process changes • Support data validation and reporting tied to PBM operations projects, such as claims, eligibility, and formulary data • Support CMS reporting obligations, including Section 111 Medicare Secondary Payer (MSP) data submissions and Retiree Drug Subsidy (RDS) reporting, helping track deadlines, reconcile data, and resolve discrepancies • Identify opportunities to improve PBM operations workflows and help implement process improvements • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree or equivalent work experience • 2+ years of experience in PBM, pharmacy benefits, or healthcare operations preferred • Exposure to accreditation processes (e.g., URAC) or government programs (e.g., EGWP) is a plus, though not required • Familiarity with CMS regulatory reporting, such as Section 111 MSP or RDS, is a plus, though is not required • Strong organizational skills, with the ability to manage multiple projects and deadlines simultaneously • Excellent written and verbal communication skills • Comfortable coordinating across teams and driving progress without direct reporting authority • Detail-oriented with a proactive, problem-solving mindset • Experience supporting audits or accreditation processes • Experience in a fast-paced, high-growth operations environment