Principal TPM – PBM Benefit Data Integrations

Prescryptive Health, Inc.•Washington, DC

About The Position

Prescryptive Health is a healthcare technology company delivering solutions that empower consumers. Prescryptive’s secure, mobile-first products connect consumers, pharmacists, and employers, ultimately providing people with the information they need to make informed decisions and take control of their health. To learn more about Prescryptive Health, visit Prescryptive.com. About this role The Principal TPM – PBM Benefit Data Integrations serves as the senior delivery owner for complex PBM benefit system and adjudication data initiatives. This role is accountable for end-to-end program execution across claims processing, eligibility, accumulators, and interconnected healthcare data platforms. This role integrates, profiles, conforms, and maps complex data from disparate systems while providing oversight for data quality assurance and root-cause resolution. The Principal TPM – PBM Benefit Data Integrations partners closely with business stakeholders, internal engineering teams, and external vendors to translate complex business requirements into scalable technical solutions that align with operational and strategic objectives. This position combines deep PBM claims expertise with enterprise-level program governance. The Principal TPM owns delivery timelines, proactively manages risks and dependencies, coordinates remediation efforts when failures occur, and ensures implementation readiness across benefit data ecosystems.

Requirements

Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or related quantitative field (required).
10+ years of progressive experience in healthcare analytics, PBM operations, data integration, or business systems analysis (required).
Experience within a PBM or healthcare claims processing environment (required).
Deep expertise in PBM benefit configuration, adjudication logic, eligibility, and accumulator integrations.
Advanced proficiency in SQL (advanced querying and data investigation)
Experience managing delivery timelines, risks, dependencies, and remediation coordination.
Working knowledge of ANSI/NCPDP Telecommunication Standard
Working understanding of PBM or TPA claim processing
Experience with data ETL processes and file delivery mechanisms (SFTP, PGP)
Experience with job scheduling automation and alerting tools
Microsoft Azure cloud experience, including blob storage
Integration testing and UAT coordination experience

Nice To Haves

Familiarity with C#, Java, JavaScript, Python, or R preferred
Experience with RxLogic or similar pharmacy benefits and claims adjudication platform
Experience supporting eligibility and accumulator reconciliation processes
Experience designing scalable data architecture
Experience working in cloud-based healthcare data environments

Responsibilities

Own end-to-end delivery of PBM benefit data integration initiatives impacting claims, eligibility, accumulators, and related platforms.
Identify, assess, and manage program risks, including coordinating root-cause remediation efforts in partnership with engineering and operations teams.
Drive cross-functional alignment on technical and operational requirements to ensure scalable, compliant integration design.
Design and validate scalable solution architectures supporting claim processing, eligibility, accumulators, and reporting.
Partner cross-functionally with business stakeholders, internal development teams, and external vendors to improve systems, workflows, and data accuracy.
Own delivery timelines, milestone tracking, and executive-level reporting for benefit data integration initiatives.
Coordinate implementation readiness including rollback planning, validation artifacts, and post-deployment support models.
Ensure adherence to security standards, data governance practices, and operational policies.
Drive implementation validation including testing, rollback planning, data migration, and post-install support.
Integrate and conform complex data from multiple sources including claims, provider, member, encounter, eligibility, and accumulator files to ensure integrity and operational continuity.
Conduct advanced data profiling and mapping to ensure alignment between source and target systems.
Monitor and resolve daily member eligibility and accumulator discrepancies arising from file imports and monthly reconciliations.
Develop and execute SQL queries to support investigation, validation, regression testing, and operational research.
Format and prepare data for one-off file loads, testing, and special projects (e.g., MPAs, formularies).
Drive cross-functional remediation strategies for complex production issues impacting benefit data integrity.
Anticipate potential system or data failures and proactively implement preventative solutions.
Present findings, business impact assessments, and recommended remediation plans to leadership and stakeholders.
Gather, validate, and document business and technical requirements.
Analyze requirements for completeness, feasibility, and standards alignment.
Assess functional and non-functional requirements and design scalable technical solutions.
Identify architectural impacts and recommend system enhancements.
Deliver implementation guidance including rollback strategies, support plans, and validation artifacts.
Plan and coordinate integration testing and User Acceptance Testing (UAT).
Perform claim testing using PBM platforms and tools such as Postman.
Conduct regression testing and validate system enhancements prior to deployment.
Support ETL processes, file transfers (SFTP/PGP), and job scheduler automation.
Assist in ensuring SLA compliance.
Maintain system documentation and operational procedures.
Communicate technical findings and data-driven insights to both technical and non-technical stakeholders.
Collaborate with internal development teams and external vendor/client development teams.
Present recommendations to leadership and incorporate stakeholder feedback.
Adhere to security management practices and promote established data governance standards.
Comply with all organizational policies and regulatory requirements.
Perform other duties as assigned.