Tpa Operations Manager Jobs (NOW HIRING)

Overview
The Sr. Operations Analyst is responsible for the implementation of new clients and support ongoing maintenance of client and third-party administrator (TPA) electronic data interchange (EDI) processing. The senior analyst serves as a subject matter expert and leads complex integration setup projects within operations. These integrations utilize systems and applications for loading batch files, monitoring automated jobs, identifying file/data issues and resolving data exceptions. These processes keep medical coverage eligibility, member demographics, and claim/deductible balance accumulators in sync between VytlOne's PBM platform and our client's systems. Reporting to the Sr. Manager, Client Integration, the Sr. Operations Analyst will meet all service standards to ensure client satisfaction.
Position Location
This is a remote-based position within the Continental US.
Who We Are
VytlOne is the nation's only independent, fully integrated total pharmacy solutions partner. We lead with integrity, offering mission-driven hospitals, health systems, health centers, and employer partners a smarter way to unlock revenue, growth, and better outcomes. Our innovative model combines customized pharmacy management, 340B program expertise, specialty pharmacy, and PBA/PBM solutions-delivering excellence through tailored strategies and collaborative partnerships. At VytlOne, we're not just transforming pharmacy-we're making a purposeful impact on the communities we serve.
Why Choose a Career at VytlOne?
At VytlOne, our purpose is at the heart of everything we do. People join us not just for a job, but to be part of something bigger-where their work truly matters. We foster a culture of authenticity, where you're encouraged to be yourself and a place to grow, collaborate and make an real difference. With over 1,600 passionate professionals across nearly every U.S. state, we operate as One Team, united by a bold mission and a spirit of innovation. Here, you'll find a place where your ideas are heard, your contributions are valued, and your career can thrive.
Responsibilities
5+ years of experience as an operations analyst and/or relevant pharmacy benefit management (PBM) experience
Proven ability to serve as subject matter expert (SME) on file integration processes for new and existing clients utilizing VytlOne's systems/applications and best practices
Proven ability to lead complex client integrations, data conversions and perform data reconciliation across systems and counterparties
Knowledge of electronic file exchange (EDI), databases management systems (DBMS)data manipulation and analysis
Advanced knowledge of client operations for pharmacy benefit management (PBM)integrations and capable of learning new applications/processes
A desire to problem solve, think critically, analyze and interpret data
A desire to develop processes and tools to more effectively manage operational tasks
Ability to research issues and collaborate with internal/external partners though resolution
Ability to effectively collect and document customer requirements and knowledge share
Strong organization skills with the ability to multi-task
Excellent verbal and written communication skills
Advanced knowledge of personal computers, including Windows Operating Systems,
MS Office (Excel, MS Access, Word, Outlook)
MS SQL Server Management Studios (Or other SQL querying language)
Familiarity using AI-enabled tools for business analysis, such as data interpretation, documentation, or operational insights
Qualifications
Education: Bachelor's degree or equivalent combination of education and experience
5+ years of progressive experience in:
PBM operations
Claims processing
Eligibility / accumulator processing
Client integrations
Health plan or TPA operations
Data operations / reporting
Knowledge, Skills, and Abilities:
Process and support daily/weekly client batch file updates working directly with account managers, implementation teams and clients.
Conduct member and file research, file processing, manual updates, data analysis, troubleshoot and resolve integration and data quality issues.
Demonstrate subject matter expert knowledge of VytlOne's PBM platform, application, file integration functions/standards and client specific configurations.
Demonstrate knowledge of pharmacy benefit administration, coverage eligibility, claim/deductible accumulators, and setup/configuration within VytlOne's systems.
Handle routine work stream assignments and ensure quality, service levels, productivity and customer standards are consistently met.
Comply with VytlOne's Ethical Business Conduct policy and Maxor's Compliance Program.
Complete required training, as assigned, within the established timeframes.
Must demonstrate resilience and professionalism when handling complex, time-sensitive responsibilities.
Promote teamwork and best practices
Maintain regular attendance in accordance with established policies.
WE OFFER
At VytlOne we offer a diverse and inclusive work culture that supports a flexible work model in a collaborative, innovative team-oriented environment. You'll work with a mission-driven organization focused on improving healthcare outcomes.
Enjoy competitive compensation, a comprehensive health benefits package, and a supportive team environment including:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
• Company-paid basic life/AD&D, short-term and long-term disability insurance
• Rx, dental, vision, other voluntary benefits, and FSA
• Employer-matched 401k Plan
• Industry-leading PTO plan
• And more!

Join us and help build the future of pharmacy care - better outcomes, stronger margins, and healthier communities.
VytlOne is an EOE, including disability/vets
The anticipated starting base salary range for this position is $65,000-$95,000. Actual compensation will be determined based on experience, qualifications, geographic location, and other job-related factors. This range reflects our good-faith estimate of what we expect to pay for this role at the time of posting.
FOR MORE INFORMATION:
VytlOne Website VytlOne LinkedIn