Responsibilities

Ready to become the architect who turns pharmacy complexity into client wins?

What You'll Actually Do

• Architect end-to-end TPA solutions: Design operational workflows across eligibility, claims, billing, and benefit administration that stay compliant, scale with client growth, and hold up against real market demands.
• Translate complexity into execution: Turn ambiguous, cross-functional operational requirements into structured solutions that Claims, Eligibility, Implementation, Account Management, Finance, Compliance, and Tech Ops can actually run with.
• Own PBM solution design: Serve as the go-to architect for pharmacy-related work, mapping current-state systems and building future-state data flows and file exchanges that actually hold up in production.
• Negotiate data standards: Partner with Pharmacy Strategy to lock in file formats, data exchange standards, and SLAs that protect data integrity and client outcomes.
• Manage PBM partnerships: Lead performance reviews and escalation management with PBM partners, and drive new vendor onboarding end-to-end — legal, data-sharing, and technical requirements all cleared before go-live.
• Shape PBM product offerings: Partner directly with PBMs to influence what gets built for current and prospective clients.
• Build internal expertise: Develop training materials and educate Account Management, Implementation, and Tech Ops on the PBM landscape and broader TPA operations, so the whole organization gets sharper.
• Track financial performance: Monitor drug cost containment, PMPM performance, and vendor cost outcomes, and flag savings opportunities clients are leaving on the table.
• Manage pricing and rebates: Maintain accurate pricing structures and rebate guarantees, and negotiate rebate and pricing agreements directly.
• Drive operational visibility: Give leadership clear insight into TPA and PBM operational health, represent program performance in client reviews, and build the SOPs and documentation that keep continuous improvement moving.

Qualifications

What You Bring to Our Team

Education & Experience:

• 7+ years of experience in healthcare, TPA operations, product, systems architecture, implementation, or related fields
• Background in PBM operations, data file formats, data dictionaries, and compliance requirements
• Experience with pharmaceutical rebate structures, formulary management, and drug cost containment strategies
• Working knowledge of legal and regulatory requirements governing PBM operations and data sharing (HIPAA, CMS, etc.)
• Track record mapping complex processes and building end-to-end workflow designs

Technical Skills:

• Data management systems and analytics tooling
• PBM data file formats and data exchange standards
• Rebate and pricing agreement structures
• Process documentation and SOP development tools

Work Environment 

Disclaimer 

This job description is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general description of the scope and function of the role within the company. Activities, duties, and responsibilities are subject to change at any time with or without notice. 

Benefits

The Highlights:

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a base salary range of $85,000-$118,000, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.