PBM Operations Associate

Rightway • Miami, FL

6d • $70,000 - $85,000

About The Position

The PBM Operations Associate supports cross-functional projects across PBM operations, helping ensure strategic initiatives, audits, and internal projects move forward smoothly and stay on track. You'll work closely with teams across the organization, tracking deliverables, coordinating operational involvement, and keeping stakeholders aligned as priorities evolve. This is an execution-focused, detail-oriented role suited for someone who enjoys bringing structure to cross-functional work and can manage multiple work streams at once.

Requirements

• Bachelor's degree or equivalent work experience.
• 2+ years of experience in PBM, pharmacy benefits, or healthcare operations preferred.
• Strong organizational skills, with the ability to manage multiple projects and deadlines simultaneously.
• Excellent written and verbal communication skills.
• Comfortable coordinating across teams and driving progress without direct reporting authority.
• Detail-oriented with a proactive, problem-solving mindset.

Nice To Haves

• Exposure to accreditation processes (e.g., URAC) or government programs (e.g., EGWP) is a plus, though not required.
• Familiarity with CMS regulatory reporting, such as Section 111 MSP or RDS, is a plus, though is not required.
• Experience supporting audits or accreditation processes.
• Experience in a fast-paced, high-growth operations environment.

Responsibilities

• Support cross-functional projects across PBM operations, including go-live management and other strategic initiatives.
• Assist with client and plan implementations, coordinating across teams to help ensure accurate benefit setup, testing, and a smooth go-live.
• Provide pre- and post-audit support, managing deliverables and tracking to ensure timely, accurate completion.
• Coordinate Ops involvement across internal projects that require operational input or support.
• Track project timelines, deliverables, and action items, flagging risks or delays as they arise.
• Maintain clear, organized documentation, including SOPs and process trackers, to support visibility across projects and teams.
• Partner with cross-functional stakeholders, including Clinical, Client Services, IT, and Compliance, to help ensure operational readiness for new initiatives and process changes.
• Support data validation and reporting tied to PBM operations projects, such as claims, eligibility, and formulary data.
• Support CMS reporting obligations, including Section 111 Medicare Secondary Payer (MSP) data submissions and Retiree Drug Subsidy (RDS) reporting, helping track deadlines, reconcile data,and resolve discrepancies.
• Identify opportunities to improve PBM operations workflows and help implement process improvements.
• Perform other duties as assigned.

Benefits

• Compensation offered will be determined by geographic location, experience, and qualifications.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level