Plan Design Analyst
About The Position
This role will be responsible for the end-to-end creation and ongoing maintenance of client Implementation Guides, which are critical to accurately configuring pharmacy benefits for our clients. This responsibility is currently handled by the Client Success Team, but given the complexity and technical nature of these documents, it is essential that this function transitions to subject matter experts within Plan Setup. This role requires expert-level knowledge of prescription benefits, strong systems understanding, and the ability to interpret complex plan design documentation from other carriers. Analysts will ensure plan designs meet client expectations while complying with regulatory requirements and system capabilities.
Requirements
- Minimum 3-5 years experience in pharmacy benefits, PBM operations, or healthcare plan configuration
- Deep understanding of prescription benefit design, clinical programs, and plan configuration systems
- Proven ability to interpret plan design documents from external carriers
- Knowledge of ACA mandates and state-specific benefit rules
- Extremely detail-oriented and organized
- Strong time management and prioritization skills
- Excellent communication and collaboration skills
- Experience working cross-functionally with implementation or client-facing teams
Nice To Haves
- Experience with benefit setup in a PBM system
- Familiarity with health plan or TPA operations
- Process improvement or documentation experience
Responsibilities
- Own the development and updates of Implementation Guides for all new and renewing clients
- Analyze and interpret external carrier plan designs to create accurate, system-ready documentation
- Collaborate closely with the Client Success, Clinical and Plan Setup teams to ensure alignment and accuracy
- Evaluate benefit interdependencies and ensure all plan design configurations are logically consistent and complete
- Articulate benefit design options, limitations, and best practices to internal stakeholders
- Stay current on ACA requirements, state regulations, and clinical program capabilities
- Support testing and validation processes during implementation cycles
- Maintain version control and auditability of Implementation Guides
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
101-250 employees
