Benefit Team Lead

Pharmpix

8h•Onsite

About The Position

The Benefits Team Lead position provides hands‑on leadership, subject matter expertise, and operational oversight while partnering closely with cross‑functional teams to support quality, system integrity, and continuous improvement. The ideal candidate thrives in a fast‑paced environment, demonstrates strong judgment, and leads by example through collaboration, accountability, and service excellence.

Requirements

Fully bilingual English and Spanish (Required).
Strong working knowledge of benefit plan setup, validation, and claims processing concepts.
Proficiency with benefits administration systems (OneArk experience preferred).
High attention to detail with strong analytical and problem‑solving skills.
Excellent written and verbal communication skills, with the ability to explain complex concepts clearly.
Proven ability to collaborate effectively across departments and with diverse stakeholders.
Strong customer service orientation with sound judgment and professionalism.
Ability to manage competing priorities and perform effectively in a fast‑paced environment.
Proficient in Microsoft Office.
Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.
Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals.
Ability to read and interpret documents, write reports and correspondence.
Ability to organize and integrate organizational priorities and deadlines.
Ability to work independently or part of a team.
Ability to support clients with technical difficulties in a timely manner.
Strong problem analysis and decision-making skills.

Nice To Haves

Pharmacy Technician Associate Degree or equivalent professional experience.
Puerto Rico Board of Pharmacy Technician Certification.
One (1) year experience in a PBM/Health Plan Environment or; Retail Pharmacy or; Proven working experience as a data analyst.
Experience in health insurance industry or PBM is desired.
Knowledge of federal and The Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies is preferred.

Responsibilities

Foster a positive, collaborative, and service‑driven team culture through active listening, approachability, respectful communication, and consistent leadership behaviors.
Provide day‑to‑day guidance, coaching, and knowledge sharing to Benefits team members to support accuracy, engagement, and professional growth.
Serve as the first‑line point of contact for Benefits team inquiries, offering clear, empathetic, and solution‑oriented guidance.
Model professionalism, patience, and a customer‑centric mindset in all interactions.
Oversee daily benefits operations, ensuring compliance with regulatory requirements, internal controls, organizational policies, and PharmPix guidelines.
Coordinate and prioritize daily workload assignments to ensure accuracy, efficiency, and adherence to established Benefit Resolution Time targets.
Review and validate client benefit configurations to ensure alignment with business rules and client intent.
Identify discrepancies, inaccuracies, or unintended outcomes and take corrective or preventive action as appropriate.
Serve as a Subject Matter Expert (SME) on OneArk system functionality, supporting operational teams with configuration guidance and issue resolution.
Oversee updates and ongoing maintenance of benefit validation tools and macros.
Act as the primary point of contact for Quality Internal Audits (QIA) and Validation requests; oversee, resolve, and document assigned tickets.
Provide guidance to team members on QIA and Validation findings to promote quality, consistency, and compliance.
Research and respond to claims processing, accumulation, and system configuration inquiries from internal partners.
Support User Acceptance Testing (UAT) from a Benefits perspective by developing and executing test plans, scenarios, scripts, and procedures based on change requirements.
Identify, document, and escalate defects, configuration issues, and design gaps during testing activities.
Partner with testers, system analysts, developers, and business stakeholders to support system readiness and successful implementation.
Collaborate closely with Benefits, Quality, IT, Operations, and other internal teams to resolve complex benefits and operational inquiries.
Review and analyze client system requests and work to accommodate needs within existing functionality prior to recommending enhancements.
Proactively identify process gaps, risks, and operational inefficiencies; perform root cause analysis and present recommendations to leadership.
Lead or support process improvement initiatives that enhance efficiency, accuracy, scalability, and employee experience.
Support Quality Management Program initiatives by promoting accuracy, compliance, and continuous improvement.
Respond promptly and professionally to requests, consultations, and escalations.
Meet deadlines in fast‑paced, high‑pressure environments and proactively communicate risks, concerns, or delays.
Support internal and external presentations and training sessions by developing clear, professional, and visually effective materials.
Perform other related duties as assigned.