Role Description

The Formulary Operations Specialist is responsible for the technical configuration, maintenance, and quality assurance of drug formularies within our adjudication systems. As a primary steward of data accuracy across multiple platforms, you will ensure information remains synchronized and reliable to support seamless functionality across the entire organization. You will leverage advanced data manipulation skills to translate clinical strategies into flawless operational execution.

What you will do:

• System Configuration & Coding: Execute complex formulary coding within adjudication systems, ensuring clinical intent is accurately reflected in system logic.
• Data Management: Utilize Advanced Excel and Google Sheets (VLOOKUP, Index/Match, Pivot Tables, and complex nested formulas) to manipulate large datasets.
• Adjudication Oversight: Apply deep knowledge of PBM hierarchies and adjudication logic to troubleshoot rejected claims and optimize system performance.
• Project Leadership: Manage multiple high-priority projects simultaneously, shifting priorities fluidly to meet urgent client needs or business deadlines.

Qualifications

• Minimum of 2 years of direct experience in a PBM or Managed Care environment.
• Having an active Pharmacy Technician license or registration is highly preferred.
• Expert-level capability in Excel and Google Sheets, specifically for data cleaning, transformation, and complex formula building.
• Proven experience in formulary management systems and a strong grasp of adjudication coding and hierarchy structures.
• Deep knowledge of Medispan drug information or similar drug database platforms.
• Exceptional critical thinking skills and the ability to solve complex problems independently.
• Meticulous attention to detail when managing high-stakes data updates.
• The ability to thrive and remain composed in a demanding, constantly evolving landscape.
• Strong organizational skills with the ability to manage timelines and prioritize tasks according to business and client urgency.
• The ability to look beyond the immediate task to understand how system updates ripple through the entire system.

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance.
• Flexible Spending Benefits.
• 401(k) Retirement Savings Program.
• Short-term and long-term disability.
• Discretionary Paid Time Off.
• Paid Company Holidays.
• Wellness Benefits.
• Commuter Benefits.
• Paid Parental Leave benefits.
• Employee Assistance Program (EAP).
• Well-stocked kitchen in office locations.
• Professional development and training opportunities.