PBM Operations Associate

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

🚫👨‍🎓 No degree required

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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 execution of eligibility and accumulator file feeds and interfaces from implementation through ongoing operations and maintenance • Support claims extract file feeds, ensuring data is accurate, complete, and delivered to external stakeholders on schedule • Serve as a day-to-day resource for eligibility, accumulator, and claims extract data needs • Collaborate with engineering, client success, implementations, benefit administration, and other internal stakeholders • Monitor downstream vendor feeds and third-party integrations, escalating and troubleshooting issues • Research and troubleshoot day-to-day inquiries or issues related to eligibility, accumulators, and claims data feeds • Maintain accurate, up-to-date documentation of processes and internal controls • Take on additional responsibilities as business needs evolve and work additional hours during peak seasons when needed

🎯 Requirements

• Bachelor's degree preferred; relevant experience considered for exceptional candidates • 2–4 years of experience in healthcare operations, PBM, health plan, or data/eligibility operations; entry-level candidates with strong analytical skills encouraged to apply • Detail-oriented and organized, with strong ownership and ability to work in a fast-paced environment with shifting priorities • Comfortable learning new systems and platforms • Consultative approach with internal and external stakeholders • Working knowledge of Excel • Ability to research and troubleshoot data discrepancies • Experience with eligibility, accumulator, or claims file feeds

🏖️ Benefits

• Bonus • Equity • Remote work arrangement