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Rx Valet, LLC

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PBM Operations Manager

Lawrenceville, GA · On-site

$65K - $85K/yr

Rx Valet is seeking an experienced, results-oriented PBM Operations Manager to lead our Shield PBM ... Strong analytical and problem-solving abilities. * Proficiency with Microsoft Office and ...

Rightway

Analytics Engineer

New York, NY · On-site

Apply hands on analytics and data expertise to solve complex, fast moving financial and operational problems using PBM data. * Design, develop and maintain scalable, analytics ready data models ...

Rightway

Analytics Engineer

New York, NY · On-site +1

Apply hands on analytics and data expertise to solve complex, fast moving financial and operational problems using PBM data. * Design, develop and maintain scalable, analytics ready data models ...

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Pbm Operations Analyst information

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How much do pbm operations analyst jobs pay per year?

As of Jun 6, 2026, the average yearly pay for pbm operations analyst in the United States is $115,859.00, according to ZipRecruiter salary data. Most workers in this role earn between $88,500.00 and $138,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced by PBM Operations Analysts, and how can they be effectively managed?

PBM Operations Analysts often encounter challenges such as managing large volumes of complex prescription data, ensuring compliance with regulatory requirements, and coordinating across different departments like claims processing, IT, and customer service. Effective management involves strong attention to detail, clear communication with cross-functional teams, and continuous learning to keep up with industry changes. Leveraging robust data analytics tools and maintaining well-documented processes can also help analysts address these challenges efficiently.

What is the difference between Pbm Operations Analyst vs Pbm Analyst?

AspectPbm Operations AnalystPbm Analyst
CertificationsTypically requires certifications like CPC or CPhTSimilar certifications, often including CPC or related credentials
Work EnvironmentFocuses on operational processes, data analysis, and workflow managementEmphasizes data analysis, reporting, and policy interpretation
Employer & Industry UsageCommon in healthcare, pharmacy benefit management companiesUsed across healthcare and pharmacy benefit sectors

The Pbm Operations Analyst primarily handles operational workflows and process improvements within pharmacy benefit management, while the Pbm Analyst focuses more on data analysis, reporting, and policy interpretation. Both roles require similar certifications and are integral to healthcare and pharmacy benefit companies, but their core responsibilities differ slightly in focus.

What is a PBM analyst?

A PBM (Pharmacy Benefit Management) analyst is a professional who evaluates and manages prescription drug benefit programs for health plans and employers. They analyze data related to medication utilization, costs, and formulary management to optimize drug benefits and control expenses, often using data analysis tools and industry regulations.

What are PBM Operations Analysts?

PBM Operations Analysts are professionals who work within Pharmacy Benefit Management (PBM) organizations to analyze, optimize, and support the operational processes involved in managing prescription drug benefits. They are responsible for ensuring the accuracy and efficiency of claims processing, benefit configuration, and compliance with regulatory standards. These analysts often collaborate with IT, pharmacy, and client services teams to resolve issues, implement process improvements, and support client needs. Their work helps ensure that patients receive appropriate medication benefits while controlling costs for insurers and employers.

What are the key skills and qualifications needed to thrive as a PBM Operations Analyst, and why are they important?

To thrive as a PBM Operations Analyst, you need strong analytical skills, attention to detail, and a background in healthcare, pharmacy benefits, or data analysis—typically supported by a relevant bachelor's degree. Familiarity with claims processing systems, SQL, Excel, and pharmacy benefit management (PBM) software is important, and certifications like Certified Pharmacy Technician (CPhT) can be beneficial. Excellent problem-solving, communication, and organizational skills help you collaborate effectively and manage complex data-driven tasks. These abilities ensure accurate claims processing, regulatory compliance, and efficient operations within the PBM environment.

PBM Operations Analyst

Career Opportunities

Norwich, VT • On-site

Full-time

Posted 26 days ago

Job description

Description:

About TruDataRx

TruDataRx, Inc. uses objective clinical data to help clients improve the clinical efficacy and reduce the costs of pharmacy benefits for its members. We are independent from all players in the pharmaceutical manufacturing and distribution industries, enabling us to best serve our clients. We value the following characteristics in our team members:

  • Outward Mindset – foundation of our culture, which influences the right behaviors, that leads to results
  • Entrepreneurial – the ability to get things done with resources you don’t control
  • Humility – deep comfort in knowing when you don’t know and asking questions
  • Collaboration – we always give benefit of doubt that each person has something to contribute

Position Summary:

The PBM Operations Analyst is responsible for managing and maintaining accurate formulary configurations in TruDataRx’s proprietary system. This role requires expertise in pharmaceutical data standards, specifically NDC and MediSpan in reviewing, coding, and managing formulary configurations to ensure accurate, up-to-date information is maintained within the formulary system. The PBM Operations Analyst works in close collaboration with internal stakeholders, including the Pharmacy & Therapeutics Committee and Account Management, to ensure correct implementation of clinical and client-specific formulary decisions.

Essential Functions

  • Manage and maintain formulary configurations in TruDataRx’s proprietary system, ensuring alignment with P&T decisions, account-specific requirements, and industry standards utilizing MediSpan and NDC standards.
  • Monitor and implement formulary changes, including tiering, exclusions, and utilization management attributes, as directed by the Pharmacy & Therapeutics (P&T) Committee and Account Management.
  • Identify and troubleshoot system or configuration issues, escalating as needed. Proactively contribute to system optimization and process improvement initiatives.
  • Ensure Formulary accuracy and data integrity by supporting the team in regular quality control reviews as requested.
  • Prepare and update Prescription Drug Lists and other reports to support internal teams and client deliverables.
  • Serve as a resource to internal teams, providing expert support on formulary-related questions and collaborating closely with the P&T committee, Account Management and partnering with IT as needed to troubleshoot and optimize system inefficiencies.
  • Identify, surface and troubleshoot formulary system issues to determine if stemmed in configuration or system function, asking for help as needed and surfacing ways to address and optimize system inefficiencies.


Requirements:


  • Minimum of 2 years of experience in formulary operations for a pharmacy benefit manager, or a related field.
  • Strong knowledge of GPI identifiers and comfort with MediSpan and NDC-derived data.
  • Proficiency in pharmaceutical classifications, drug data, and formulary logic.
  • High attention to detail and accuracy in data entry and formulary configuration.
  • Demonstrated ability to troubleshoot system and process inefficiencies with a continuous improvement mindset.
  • Excellent organizational, written, and verbal communication skills.
  • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

Company Standard Requirements:

  • Ability to work well with others in a collaborative environment
  • Ability to get things done with resources you don’t control
  • Willingness to admit you don’t know and ask for help
  • Exhibit constant curiosity and a drive to problem solve
  • Exhibit desire to learn and grow on a continuous basis