PBM Compliance & Reporting Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $62.4k - $78k / year

⏰ Full Time

🟢 Junior

📚 Business Intelligence Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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RxBenefits, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1995

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

💰 Private Equity Round on 2020-12

Healthcare • Consulting • Healthcare Insurance

RxBenefits, Inc. is a company that specializes in providing innovative pharmacy benefits solutions to employers and their employees. They focus on optimizing the management of prescription drug plans to reduce costs and improve health outcomes. Through advanced analytics and personalized member support, RxBenefits aims to transform the pharmacy benefits experience for their clients.

📋 Description

• Support federal and state regulatory reporting, including CMS Section 111, CMS RxDC, APCD, DOI filings, DLR reporting, and other state-mandated pharmacy reporting • Collect, prepare, validate, and submit data for regulatory filings and renewals • Maintain reporting schedules and ensure filing deadlines are met • Maintain audit-ready documentation and support DOI inquiries, audits, and regulatory reviews • Review and validate eligibility, demographic, accumulator, and claims data • Reconcile PBM and internal system data, investigate discrepancies, and document exceptions and resolutions • Monitor compliance workflows and maintain regulatory tracking logs and reporting inventories • Gather supporting documentation for internal and external audits • Use PBM Source and internal systems for regulatory reporting and compliance activities • Create and manage Jira tickets and workflows; track project status and stakeholder communications • Manage and triage the Compliance & Reporting shared mailbox • Support submissions within state DOI portals and CMS-related systems • Develop and maintain SOPs, Confluence pages, work instructions, and reporting guides • Use Excel and analytical tools to prepare and validate data files, support dashboards, KPIs, and compliance metrics • Analyze reporting trends and identify process improvements • Collaborate with Legal Operations, Data Operations, IT, Pharmacy Operations, Eligibility Vendors, and PBM partners • Communicate professionally with regulatory agencies and external partners as needed

🎯 Requirements

• 1–3 years of experience in PBM operations, healthcare compliance, regulatory reporting, or data operations • Proficiency in Excel, including VLOOKUP/XLOOKUP, Pivot Tables, data validation, reconciliation, and cleansing • Strong analytical, organizational, and communication skills • Ability to manage multiple projects and deadlines with high attention to detail • Foundational knowledge of CMS reporting requirements, including Section 111 and RxDC • Knowledge of state DOI reporting processes • PBM industry experience • Experience with Jira, Confluence, or PBM Source • Working knowledge of SQL, Python, SAS, or Snowflake • Experience supporting audits or regulatory reviews • Bachelor's degree preferred

🏖️ Benefits

• Remote first work environment • Choice of a HDHP or PPO Medical plan; 100% of the HDHP premium paid for you and eligible family members • Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance; 100% of premiums paid for specified coverage • Additional buy-up options for Short- and Long-Term Disability and Life Insurance • 401(k) with an employer match up to 3.5% available after 60 days • Community Service Day • 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving, plus a floating holiday • High-speed internet reimbursement • Company-provided computer and monitors • Tuition Reimbursement for accredited degree programs • Paid New Parent Leave for adoption or birth • Pet insurance • Mental health benefit and EAP service through Spring Health • Short-term incentive eligibility

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