PBM Operations Associate

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 Associate is a member of the Rightway Operations team reporting to the Manager, Benefit Configuration. This role will be responsible for the configuration and maintenance of benefits, and related claims adjudication rules within the claim platforms.

WHAT YOU’LL DO:

Review client benefit design documentation for completeness and accuracy, flagging open items and partnering with implementation and client success to resolve gaps prior to configuration.

Configure client benefit designs in the claims adjudication platform, including plan parameters, copay structures, inclusions and exclusions, and utilization management edits, for both new client implementations and mid-year plan changes.

Develop and execute test claim scenarios to validate benefit setup prior to go-live, and perform ongoing monitoring and regression testing to confirm accuracy after changes. Research, document, and correct identified defects through to resolution.

Research and resolve inquiries related to claims adjudication and benefit configuration, partnering with client success to communicate findings and remediation steps.

Work cross-functionally with product, client success, implementation, and formulary teams to ensure benefits are built and operating according to signed client requirements.

Maintain complete, audit-ready documentation of benefit setup, testing evidence, and internal controls in support of audit and internal quality standards.

Track work across implementation and plan change trackers, keeping status, ownership, and deadlines current so cross-functional partners have real-time visibility.

WHO YOU ARE:

Bachelor’s degree preferred; relevant experience considered for exceptional candidates.

1-3 years of PBM experience in claims adjudication, benefit configuration, or testing/QA.

Pharmacy Technician certification or related pharmacy experience highly desirable.

Strong attention to detail with the ability to trace a claim outcome back to its configuration driver.

Comfortable navigating ambiguity; able to work from incomplete requirements, ask the right questions, and exercise sound judgment when documentation doesn’t cover every scenario.

Comfortable working in structured tools (Excel, Smartsheet, claims platforms) and managing multiple client deliverables against firm deadlines.

Clear written communicator who documents decisions and keeps stakeholders informed without being prompted.

COMPENSATION: $65,000 - $85,000 annually, in addition to bonus and equity.