[Remote] Formulary Operations Analyst
Note: The job is a remote job and is open to candidates in USA. RxSense is a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits. The Formulary Operations Analyst plays a key role in the configuration, maintenance, and quality assurance of formularies within the RxSense platform, supporting internal teams and external clients to execute accurate formulary strategies.
Responsibilities
- Configure, update, and maintain custom and standard formularies within the claims adjudication system
- Ensure accuracy and alignment of formulary builds with client intent, clinical strategy, and regulatory requirements
- Troubleshoot adjudication issues and discrepancies; conduct detailed analysis to resolve defects and anomalies
- Participate in client implementations by gathering and documenting formulary requirements
- Serve as a clinical capabilities subject matter expert
- Collaborate with internal teams to ensure smooth integration of formulary solutions
- Perform audits to validate formulary configuration accuracy
- Monitor claim processing to detect and correct potential issues proactively
- Assist in analyzing and presenting data related to formulary performance or disruptions
- Pull, organize, and aggregate data and reports to support client meetings and formulary strategy presentations
- Support client interactions as needed, including responding to formulary-related inquiries and assisting in training sessions
- Work closely with clinical partners to ensure translation of clinical direction into accurate system configuration
- Contribute to development and documentation of internal workflows, best practices, and training materials
- Lead or contribute to special initiatives such as process optimization, disruption analyses, or platform enhancements
- Recommend and implement improvements to ensure greater accuracy, efficiency, and scalability of formulary operations
Skills
- Bachelor's degree or 1 year equivalent experience in healthcare (PBM)
- 1+ year's of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics
- Demonstrated expertise in configuring and maintaining formulary data within claims systems
- Excellent working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations
- Strong problem-solving skills with the ability to analyze data and translate findings into actionable solutions
- Detail-oriented, with the ability to manage multiple priorities and meet deadlines
- Superior written and verbal communication skills — clear and concise with both internal and client-facing audiences
- Excellent organizational and time management skills
- Ability to take the lead on projects and follow through to completion
- Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data
- Self-starter with a proactive mindset and a high level of accountability
Company Overview
Company H1B Sponsorship