About this role
This is a hands-on technical role for a PBM data integration expert who also owns program delivery. You’ll profile, map, and validate claims, eligibility, and accumulator data, design integration architecture with engineering, and be accountable for the timelines, risks, and vendor dependencies that come with it. You’ll stay close to the data yourself: writing SQL, resolving discrepancies, and troubleshooting production issues, while directing the teams who do much of the day-to-day work.
What you will do
- Profile, map, and validate complex claims, eligibility, accumulator, and encounter data across multiple sources, and resolve daily eligibility and accumulator discrepancies arising from file imports and monthly reconciliations.
- Write and execute advanced SQL for investigation, validation, regression testing, and special data loads.
- Lead cross-functional root-cause investigation and remediation of production issues, and anticipate system and data failures before they happen.
- Partner with engineering and architects on scalable, compliant integration architecture for claims, eligibility, and accumulators.
- Own end-to-end delivery of benefit data integrations, including timelines, milestones, risks, dependencies, and executive reporting.
- Coordinate with external vendors and internal engineering, translating vendor data formats and constraints for engineering and vice versa.
- Plan and coordinate integration testing, UAT, and implementation readiness, including data migration, rollback planning, and post-deployment support.
- Communicate findings and recommendations to technical and non-technical stakeholders, and maintain system documentation and operational procedures.
What you will bring (minimum requirements)
- Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative field.
- At least 10 years of hands-on technical experience with data systems, SQL, and integrations.
- At least 6 years of direct PBM or pharmacy claims processing experience, including deep knowledge of benefit configuration, adjudication logic, eligibility, and accumulator integrations.
- Advanced SQL proficiency, including complex querying and data investigation.
- Experience supporting eligibility and accumulator reconciliation processes.
- Experience designing scalable data architecture for healthcare data systems.
- Experience managing delivery timelines, risks, and dependencies, and coordinating integration testing and UAT.
- Working knowledge of the ANSI/NCPDP Telecommunication Standard and PBM or TPA claims processing.
- Hands-on experience with ETL, secure file transfer (SFTP/PGP), and job scheduling and alerting tools.
Ideally you will also have
- Experience with a pharmacy benefits adjudication platform.
- Cloud experience, ideally Microsoft Azure, in healthcare data environments.
- Familiarity with C#, Java, JavaScript, Python, or R.
What we have to offer
• The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry.
• Flexible time off, including 12 paid holidays.
• 401k match plus 100% employer-provided medical, dental, and vision premiums.
• Company contribution to Health Savings Account.
• Stock options.
Prescryptive is committed to fair pay practices. The projected annual salary range for this position is $148k - $205k. When preparing an offer, we also consider relevant experience, internal equity, and location.
