Director, System Configuration and Process Improvement

LucyRx•Bethesda, OH

1d•Remote

About The Position

The Director, System Configuration and Process Improvement, will serve as a senior leader within our operations team, responsible for two critical and interconnected functions: the accurate, scalable configuration of pharmacy network and client pricing systems, and the design and execution of Process Improvement initiatives. This is a highly visible, hands-on leadership role that requires deep PBM operational expertise and the ability to drive measurable outcomes across both system integrity and operational excellence. The Director will oversee the full lifecycle of system configuration—from contract interpretation through deployment and quality assurance—while simultaneously establishing and advancing a formal Process Improvement program that impacts clients, members, and internal teams alike.

Requirements

5+ years of experience in PBM, health plan, or healthcare benefits administration, with at least 3 years in a leadership role spanning operations, system configuration, process improvement, or operational excellence.
Deep understanding of pharmacy benefit operations, including claims adjudication, formulary structures, utilization management, benefit configuration, pharmacy network setup, and member/client services.
Hands-on experience with pharmacy network and client pricing configuration within PBM claims processing systems, including MAC, U&C, AWP, WAC, dispensing fees, and specialty pricing models.
Proven experience building or enhancing Process Improvement programs, frameworks, or processes from the ground up.
Expertise in process improvement methodologies (Lean, Six Sigma, or equivalent); certification preferred.
Proficiency with data tools such as Excel, SQL, or BI platforms; ability to translate complex data into clear insights and actionable recommendations.
Ability to interpret complex contract terms and convert them into precise system logic and configuration rules.
Experience working cross-functionally in a fast-paced, deadline-driven environment with strong communication and influencing skills.
Familiarity with PBM platforms, claims systems, or adjudication engines.
Demonstrated ability to lead high-performing teams through change and drive sustainable operational results.
High attention to detail and commitment to accuracy in both configuration and process improvement work.

Nice To Haves

Bachelor degree in Business, Finance, Data Analytics, Healthcare Administration, or a related field

Responsibilities

Lead and oversee the configuration and maintenance of client billing and pharmacy network reimbursement terms (MAC, U&C, brand/generic rates, specialty pricing, etc.) within PBM claims processing systems.
Interpret complex contract language and translate it into precise system rules, rate tables, and network attributes.
Direct the development and implementation of pricing structures for retail, mail, and specialty networks, including pricing libraries, rate matrices, and configuration standards.
Validate network and client configurations through test claims and scenario modeling to ensure accuracy prior to deployment.
Perform root cause analyses on pricing or reimbursement issues identified through audits, escalations, or client inquiries, and drive timely and sustainable resolution.
Ensure all system configurations comply with internal controls, regulatory requirements, and contractual obligations.
Maintain thorough documentation of configuration decisions, methodologies, and testing results to support consistency and auditability.
Partner with Network Contracting, Client Services, Operations, and IT to ensure full alignment on pricing and network requirements across client implementations, renewals, and custom requests.
Design, launch, and continuously refine a comprehensive Process Improvement program, including frameworks, workflows, documentation standards, and performance metrics.
Establish PI methodologies—including process mapping, gap analyses, root cause analyses, and improvement protocols—tailored to PBM operations and benefit administration.
Partner with cross-functional teams—Configuration, Clinical, Operations, Client Services, and IT—to ensure alignment on performance standards, improvement initiatives, and implementation timelines.
Develop and maintain PI policies, SOPs, and best practices to support consistent, repeatable, and auditable improvement processes.
Serve as the primary point of contact for Process Improvement inquiries and initiatives across the organization.
Must have personally designed and implemented a centralized Process Improvement function or framework across multiple business units.
Conduct detailed operational reviews across key PBM functions, including claims processing, benefit configuration, formulary management, utilization management, and member/client services.
Identify performance gaps and inefficiencies through data analysis, audits, and stakeholder feedback, and develop targeted improvement plans.
Lead root cause analyses for operational failures, errors, or client escalations and partner with cross-functional teams to drive sustainable resolution.
Build and maintain performance benchmarks, scorecards, and tracking tools to support ongoing improvement activities.
Monitor trend data to proactively surface opportunities for process optimization and automation.
Participate in audits, remediation activities, and continuous improvement initiatives related to system configuration and operational performance.
Ensure all processes and configurations adhere to internal controls, compliance standards, and industry best practices.
Define and track KPIs related to configuration accuracy, operational efficiency, error rates, turnaround times, and client satisfaction.
Deliver clear, actionable reporting to leadership and key stakeholders on process trends, configuration outcomes, and improvement results.
Recommend and implement enhancements based on data insights, client feedback, and industry best practices.