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Medix™ · 1 week ago

Pharmacy Benefits Systems Analyst - 249236

Chicago, IL

Full-time

Onsite

Entry, Mid Level

$80K/yr - $100K/yr

2+ years exp

Medix™ is seeking a Pharmacy Benefits Systems Analyst responsible for building, updating, and validating pharmacy benefit plan configurations within PBM systems. This role involves collaborating with internal stakeholders to support implementations, ongoing plan changes, and compliance needs.

CrowdsourcingRecruitingSocial NetworkStaffing AgencyVenture Capital

Hiring Manager

McKenna Hinzman

Responsibilities

Design, configure, and update pharmacy benefit parameters within PBM adjudication platforms, including cost-share models, accumulators, and eligibility rules

Implement formularies, benefit tiers, utilization management edits, and plan-specific logic based on client requirements

Convert benefit design documentation, contracts, and plan amendments into actionable system build specifications

Conduct end-to-end testing and validation to confirm benefit accuracy prior to deployment and during plan updates

Provide configuration support for new group implementations, annual renewals, and mid-year plan modifications

Investigate and resolve benefit build issues affecting claims outcomes, member eligibility, or pricing

Partner with Client Services, Implementations, Clinical teams, IT, and Compliance to ensure alignment and accuracy

Maintain detailed documentation for configuration decisions, testing results, and change management

Ensure plan builds adhere to regulatory standards and contractual obligations (CMS, state, and employer-specific rules)

Assist with audits, issue resolution efforts, and continuous improvement initiatives

Manage multiple plan builds simultaneously while maintaining precision and meeting delivery timelines

Qualification

PBM operations experienceClaims adjudication workflowsPharmacy benefit structuresConfiguration in healthcare systemsAnalytical problem-solving skillsMicrosoft Excel proficiencyRoot cause analysisContinuous improvement mindsetAttention to detailWritten communication skillsVerbal communication skillsCross-functional collaboration