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Pharmacy Benefit Configuration Analyst (CPhT Preferred)

Pharmacy Benefit Configuration Analyst (CPhT Preferred)

About the Role

As part of our Benefit Configuration & Operations team, you’ll help set up and maintain client benefit plan designs and clinical programs within our PBM’s adjudication platform. You’ll work alongside internal subject-matter experts to understand how benefits function, analyze systems to identify inaccuracies, and escalate issues for timely resolution.

A background in pharmacy or benefits is highly preferred; however, expert-level proficiency is not required. Candidates with a solid foundational understanding and a strong learning mindset will be successful. You’ll receive comprehensive training tailored specifically to our organization’s workflows and quality standards, while collaborating closely with a supportive team.

Key Responsibilities

Analyze and validate requests for plan design edits, clinical rule updates, formulary changes, and new program implementations.
Translate client and internal benefit requests into accurate system configuration logic (copay, deductible, accumulator, network, formulary, UM edits, etc.).
Conduct regression testing via claim adjudication to ensure accuracy before and after benefit changes.
Maintain detailed documentation of all configurations and change requests for audit and historical purposes.
Troubleshoot and resolve claim discrepancies, ensuring timely resolution and root-cause prevention.
Work in close partnership with platform service delivery team to ensure potential issues are identified and resolved with minimal operational impact.
Monitor and respond to error or exception reports; proactively identify and correct coding discrepancies.
Prioritize and manage tasks to meet strict deadlines, respond to urgent requests, and address escalations efficiently.
Collaborate closely with Clinical, Client Services, and Operations teams to ensure benefit alignment across departments.
Support continuous improvement initiatives, process documentation, and automation opportunities.
Maintain basic knowledge of NCPDP standards relevant to claims adjudication and system setup.
Uphold confidentiality and compliance with HIPAA and company standards at all times.

What We’re Looking For

Detail-oriented and analytical — enjoys solving complex logic puzzles and validating results with precision.
Certified Pharmacy Technician (CPhT) preferred; pharmacy or PBM operations experience strongly valued.
Proficient with Microsoft Office, particularly Excel and Access
Exceptional organizational skills and comfort managing multiple projects in a fast-paced environment.
Strong written and verbal communication; able to explain technical information clearly to non-technical audiences.
Adaptable, eager to learn, and thrives in a growing, evolving organization.
Customer-focused mindset with a high degree of accountability and professionalism.
Positive team player who contributes to a culture of respect, integrity, and shared success.

Performance Expectations

Complete standard client requests within SLA timelines.
Demonstrate initiative in identifying system or process improvements.
Communicate clearly, proactively, and constructively with internal and external partners.
Consistently uphold company values of excellence, collaboration, and care.

Why Join Us

You’ll be joining a growing PBM where your precision and problem-solving directly improve member health outcomes and client trust. We are a mission-driven, people-first organization — passionate about doing what’s right for our clients and members while supporting each other’s growth.

If you’re looking for a career where your analytical skills meet meaningful impact — this is it.

Must live in Michigan.

Pay: $50,000.00 - $60,000.00 per year

Benefits: