Sr. Pharmacy Performance & Operations Specialist
Core
Oversees performance, contractual compliance, and operational execution of federal health and dental benefit pharmacy programs (FEHB/PSHB), serving as a subject matter expert and primary liaison to Pharmacy Benefit Managers (PBMs).
Role type
Senior IC pharmacy operations and PBM performance specialist
Builds
Data-driven insights, dashboards, and corrective action plans to optimize member outcomes and ensure regulatory alignment
Domain
US Federal Health Benefits (FEHB/PSHB) and Pharmacy Benefit Management (PBM)
Deliverable
dashboards & analysis
Required skills
PBM contract performance monitoring, federal program compliance, data analysis and reporting, contract interpretation, issue resolution, claims validation, cross-functional collaboration
Preferred skills
Data visualization (Tableau/Power BI), project management (PMP/CAPM), process improvement (Lean/Six Sigma), regulatory compliance knowledge
Technologies
Microsoft Office Suite, Tableau, Power BI
Responsibilities
Oversee PBM contract performance and ensure alignment with federal requirements; Prepare and validate annual pharmacy benefit changes; Develop executive-level reports and dashboards; Manage PBM contractual credits and quality assurance; Monitor call center performance metrics; Investigate and resolve complex member issues; Respond to audit inquiries; Validate claims accuracy; Coordinate cross-functional efforts for performance improvement
Seniority
Senior, hands-on IC
