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Pbm Jobs in Puerto Rico (NOW HIRING)

Pharmpix

Compliance Associate

Guaynabo, PR · On-site

Monitor and interpret regulatory changes impacting PBM operations, including CMS guidelines, HIPAA, and Medicare Part D. * Assist in maintaining compliance with Medicare regulations, including ...

APS Health Care PR

HP1 Pharmacy Technician

San Juan, PR · On-site

$16.75 - $20.25/hr

... PBM claims processing system to ensure that claims are correctly adjudicated. 5. Assists pharmacies claim processing. 6. Assist in the training of pharmacy representatives. 7. Complies with all ...

Pharmpix

Benefit Business Support

Guaynabo, PR · On-site

One (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy or; Proven working experience as a data analyst. PROFESSIONAL COMPETENCIES Knowledge: * Experience in health ...

Pharmpix

Financial Analyst

Guaynabo, PR · On-site

PBM and/or Medicare experience, preferred. PROFESSIONAL COMPETENCIES Knowledge: * Expert Knowledge in MS Office, mainly Excel and Power BI. * Basic SQL knowledge, preferred. * Fully bilingual English ...

Abarca Health LLC

Data Integration Manager

San Juan, PR · On-site

In lieu of a degree, equivalent relevant work experience may be considered. * 8+ years of experience in healthcare data integration, PBM/health plan data exchange, or related roles * Proven expertise ...

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Pbm information

What is a PBM?

A PBM (Pharmacy Benefit Manager) job involves managing prescription drug benefits on behalf of health insurers, employers, and other payers. Responsibilities often include negotiating drug prices with manufacturers, creating formularies, processing pharmacy claims, and ensuring medication cost savings. PBM professionals work in roles such as clinical pharmacists, account managers, and analysts to optimize drug coverage and improve patient outcomes.

What are the key skills and qualifications needed to thrive in the PBM position, and why are they important?

To thrive as a Pharmacy Benefit Manager (PBM), you need a solid understanding of pharmacy benefits, healthcare administration, insurance processes, and data analysis, often supported by a degree in pharmacy, healthcare management, or a related field. Familiarity with pharmacy claims processing systems, formulary management software, and compliance regulations is essential, and some roles may require pharmacy technician or pharmacist certification. Strong communication, negotiation, and organizational skills help PBMs collaborate with pharmacies, insurers, and clients while managing complex benefit structures. These capabilities are crucial for ensuring cost-effective, compliant, and efficient pharmacy benefit solutions for clients and patients.

What are some common challenges faced by Pharmacy Benefit Managers and how are they addressed?

Pharmacy Benefit Managers often encounter challenges such as staying compliant with frequently changing healthcare regulations, managing relationships between pharmacies, insurers, and clients, and controlling rising prescription drug costs. To address these challenges, PBMs work closely with cross-functional teams, leverage up-to-date technology platforms, and engage in ongoing education about regulatory requirements. Strong analytical skills help them assess and negotiate pricing strategies, while effective communication ensures all stakeholders are informed and aligned. By proactively managing these factors, PBMs play a key role in keeping healthcare affordable and accessible.

What are the most commonly searched types of Pbm jobs in Puerto Rico?

The most popular types of Pbm jobs in Puerto Rico are:

What are popular job titles related to Pbm jobs in Puerto Rico?

For Pbm jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Pbm jobs in Puerto Rico look for?

The top searched job categories for Pbm jobs in Puerto Rico are:

Pbm jobs near you
Infographic showing various Pbm job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 92% Full Time, 3% Part Time, and 4% Contract. Highlights an 59% Physical, 8% Hybrid, and 33% Remote job distribution.

Benefits Configuration Specialist I

Pharmpix

Guaynabo, PR • On-site

Full-time

Re-posted 29 days ago

Key responsibilities

  • Set up client benefit rules and configurations in the adjudication system for PharmPix clients.

  • Test claims and perform quality assurance reviews to verify system setup accuracy.

  • Act as a point of contact for system functionality and claim research questions from internal and external customers.

Job description

POSITION SUMMARY

The Benefit Configuration Specialist I report to the Benefits & Network Supervisor and is responsible for setting up business rules in the adjudication system for all PharmPix clients. The Benefit Configuration Specialist I will test claims and perform quality assurance reviews to ensure desired results.

 

ESSENTIAL ROLES AND RESPONSIBILITIES

 

  1. Perform accurate client benefit set up for all business rules for PharmPix clients.
  2. Implement new and maintain existing benefit plans, rates, and networks in the OneArk system, consistent with the direction and intent set forth by the client and PharmPix. 
  3. Properly enter test claims to verify business rules set up in the system.
  4. Perform quality assurance reviews on set up performed by other team members to ensure accuracy.
  5. Point of contact for both internal and external customers for system functionality and claim research questions.
  6. Become Subject Matter Expert on OneArk functionality to support the Operational areas and backend clients.
  7. Analyze client system requests and work to accommodate within existing systems before having to recommend system enhancements.
  8. Identify discrepancies, inaccuracies, and unintended consequences, and take corrective action. 
  9.  Research and respond to claims processing and system configuration inquiries from internal departments and backend clients. 
  10.  Proactively identify setup issues and escalate to the Benefit Implementation Director or Manager for immediate review and resolution. 
  11. Support all Quality Management Program initiatives.
  12. Perform other duties as assigned. 


TRAINING & EDUCATION

 

  • Pharmacy Technician Associate Degree or equivalent professional experience.

 

LICENSURE / CERTIFICATION

 

  • Puerto Rico Board of Pharmacy Technician Certification (Preferred). 

PROFESSIONAL EXPERIENCE

 

  • One (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy or; Proven working experience as a data analyst.

PROFESSIONAL COMPETENCIES

Knowledge:

  • Experience in the health insurance industry or PBM is desired. 
  • Knowledge of federal and The Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies is preferred. 

 

Skills:

  • Must be detail-oriented and highly organized.
  • Accurately analyze and interpret common Pharmacy Benefit terminology.
  • Manage multiple priorities and work independently in a fast-paced environment.
  • Proficiency in Microsoft Office.
  • Possess a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
  • Strong verbal, written and presentation communication skills.


Abilities: 

  • Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.
  • Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals.
  • Ability to read and interpret documents, write reports and correspondence. 
  • Ability to organize and integrate organizational priorities and deadlines.
  • Ability to work independently or part of a team.
  • Fully bilingual English and Spanish.
  • Strong problem analysis and decision-making skills.


PHYSICAL AND MENTAL DEMANDS

 

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear, sitting, standing, and walking
  • The position requires that weight be lifted, and force be exerted up to 25 pounds.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

ENVIRONMENTAL AND WORKING CONDITIONS

 

  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Require evening or weekend work.

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans