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

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