PBM Operations Analyst
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them. Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
ABOUT THE ROLE:
Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers
The PBM Operations Analyst is a member of the Rightway Operations team reporting to the Director, Claims & Data Operations. This role will be responsible for the configuration, testing and maintenance of benefits, and related claims adjudication rules within the claim platform along with ongoing management of data operations.
WHAT YOU'LL DO:
- Support the execution of all eligibility and accumulator operations and interfaces from implementation through ongoing operations and maintenance.
- Serve as day-to-day contact for all eligibility and accumulator needs.
- Collaborates with technology, account management, benefit administration, and other internal stakeholders to ensure that eligibility and accumulator functions are implemented and operating in accordance with requirements.
- Oversee all downstream vendor feeds (i.e. ID card fulfillment), third party integrations (i.e. health plans, TPAs) and ensures all deliverables are met timely and troubleshoots issues.
- Configures benefits into the claim adjudication platform, including benefit inclusions/exclusions copay, accumulator, and other benefit parameters.
- Develops and executes on test scenarios to ensure accuracy of benefit setup both at initial setup and conducts ongoing monitoring and regression testing. Works to correct all identified defects.
- Performs research and troubleshoots inquiries or issues related to claims adjudication, accumulators, and eligibility.
- Ensures all documentation regarding setup and internal controls is always up to date.
WHO YOU ARE:
- Bachelor’s degree preferred. Relevant experience considered for exceptional candidates.
- Pharmacy Technician or related experience highly desirable
- 1-3 years of PBM experience in claims or benefit configuration
- Location information: NYC or Denver, highly qualified remote candidates will be considered
SALARY RANGE :
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:
1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
4) We cultivate grit
Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.
Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.