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Pbm Implementation Jobs in Boston, MA (NOW HIRING)

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Pbm Implementation information

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$15

$37

$78

How much do pbm implementation jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for pbm implementation in Boston, MA is $37.03, according to ZipRecruiter salary data. Most workers in this role earn between $27.40 and $37.88 per hour, depending on experience, location, and employer.

What is a PBM Implementation specialist?

A PBM Implementation specialist is a professional who manages and oversees the process of integrating pharmacy benefit management (PBM) services for clients, such as health plans or employers. Their role involves coordinating system setups, benefit configurations, and data transfers to ensure accurate and efficient delivery of prescription drug benefits. They work closely with internal teams and clients to understand requirements, resolve issues, and ensure a smooth transition to PBM services. Strong communication, project management, and technical skills are essential in this role.

What are the key skills and qualifications needed to thrive as a PBM Implementation specialist?

To thrive as a PBM Implementation Specialist, you need a solid understanding of pharmacy benefit management, project management skills, and familiarity with healthcare regulations, often supported by a relevant bachelor’s degree. Experience with PBM software platforms, data integration tools, and possibly certifications like PMP are highly valued. Outstanding problem-solving, attention to detail, and strong communication skills set top performers apart in this role. These skills are essential for ensuring seamless implementation of PBM solutions, minimizing errors, and maintaining compliance in a complex, regulated environment.

What are some common challenges faced during PBM implementation projects, and how can they be addressed?

One of the main challenges in PBM (Pharmacy Benefit Management) implementation is coordinating between multiple stakeholders, such as clients, vendors, and internal IT teams, to ensure accurate data integration and system configuration. This role often requires managing tight deadlines and rapidly resolving issues that arise during system testing and member migration. To address these challenges, strong project management skills, clear communication, and a proactive approach to identifying potential risks are essential. Collaboration with cross-functional teams and maintaining detailed documentation can also help ensure a smooth implementation process.

What is the difference between Pbm Implementation vs Pbm Analyst?

AspectPbm ImplementationPbm Analyst
CredentialsRelevant certifications, technical skillsSame certifications, analytical skills
Work EnvironmentProject-based, cross-functional teamsData analysis, reporting focus
Industry UsageHealthcare, pharmacy benefit managementHealthcare, insurance, benefits analysis
Primary FocusImplementing PBM systems and processesAnalyzing data, generating insights

While both roles require similar credentials and operate within the healthcare and PBM industry, Pbm Implementation focuses on deploying and configuring PBM systems, whereas Pbm Analysts analyze data to optimize benefits and costs. The implementation role is more project-oriented, while analysts focus on data insights.

What are popular job titles related to Pbm Implementation jobs in Boston, MA?

For Pbm Implementation jobs in Boston, MA, the most frequently searched job titles are:

What job categories do people searching Pbm Implementation jobs in Boston, MA look for?

The top searched job categories for Pbm Implementation jobs in Boston, MA are:

What cities near Boston, MA are hiring for Pbm Implementation jobs?

Cities near Boston, MA with the most Pbm Implementation job openings:

Pbm Implementation jobs near you

Medical Underwriting Subject Matter Expert

Southborough, MA • On-site

Rxadvance Corporation
11 - 50 employees
Learn more about Rxadvance Corporationexternal

$90K - $135K/yr

Full-time

Medical

Posted 19 days ago

Key responsibilities

  • Reverse-engineer carrier rate filings into precise, implementable factor specifications.

  • Build member-level worked examples in Excel to serve as regression fixtures and validate engine output.

  • Review engine calculations against worked examples and resolve discrepancies.

Job description

Company Overview:

Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage of life. Success radiates across all levels of our organization, driven by competitive benefits and a strong focus on employee wellness, we aim to support all aspects of employee growth.


Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.


Under the leadership of our Chairman John Sculley, former Apple CEO, and our President & CEO Ravi Ika, nirvanaHealth endeavors to sizably reduce the $1 trillion in waste in healthcare administrative and medical costs. We are seeking self-determined players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovative, are life-long learners and growers, and have an entrepreneurial and positive mindset.


Job Summary:

nirvanaHealth is building a multi-tenant rating and quote-to-installation platform for U.S. commercial health insurance — Small Group and Large Group, Fully-Insured through Level-Funded and Self-Funded. Any carrier's filed methodology loads as configuration, never code: their rate tables, their pipeline recipe, their credibility formulas, their networks. A national carrier is our first design partner, and their filed large-group methodology (a 44-table manual rating pipeline plus credibility-blended experience rating) is the engine's first calibration.


The rating engine is the pricing brain of that platform. It takes a group, its census, a plan design, and a funding type, and returns per-member, per-tier, and composite rates with a factor-by-factor explainability waterfall. Getting those numbers provably right —against filings, against regulation, against an underwriter's scrutiny — is what this role exists to do. 


You are the calculations authority: the credentialed actuary who specifies the math, builds the worked examples, and validates that the engine reproduces them exactly. Engineers implement to your spec and test against your numbers. When the engine and your spreadsheet disagree, you adjudicate — to the penny.


This is not a production-coding role. It is a methodology, specification, and validation role for someone who finds deep satisfaction in a rate build-up that ties out. Coding skills are a plus.


Job Responsibilities (but not limited to):

Reverse-engineer carrier rate filings — actuarial memoranda, SERFF exhibits, rate templates — into precise, implementable factor specifications.

  • Build member-level worked examples in Excel, every factor traced to its source table and lookup keys. These become the engine's regression fixtures.
  • Own methodology for the manual rating pipeline: base claims, trend, area factors, demographic factors, industry loads, and the multi-step cost-share (CPD) waterfall for deductibles, copays, coinsurance, and OOP maximums.
  • Keep the ACA small-group pipeline legally exact: single risk pool and index rates, federal and state age curves, family build-up, and hard enforcement of prohibited rating factors.
  • Specify experience rating end to end: credibility formulas, pooling points, shock-claim adjustment, IBNR completion, and trend to the policy period.
  • Review engine output against your worked examples with the engineering team and resolve every discrepancy. 
  • As the platform scales: translate additional carriers' filed methodologies into the same platform abstractions, and shape stop-loss and LASER pricing for level-funded products.


Education and/or Training:

  • Bachelor’s degree accounting, mathematics, finance, or similar fields required.


Professional Experience:

  • At least 5 years of total experience with medical underwriting in a health plan, managed care setting. 5+ years pricing commercial group health.
  • Experience building manual rate models: base claims development, trend, area and demographic factors, industry loads.
  • Benefit-relativity depth. Continuance tables, deductible and OOP leverage, copay/coinsurance relativities — you can explain why a $500 deductible increase moves premium roughly 4%, and why that leverage grows with trend.
  • Operational ACA small-group knowledge: 45 CFR § 147.102 factors, single risk pool mechanics, state age-curve and tobacco variations, and what is prohibited.
  • Experience-rating fluency: credibility theory, pooling, shock adjustment, completion factors.
  • Rate-filing literacy. Handed an unfamiliar carrier's fi ling, you can reverse the methodology unassisted.
  • Spreadsheet rigor and a documentation habit. Yo