PBM Operations Associate

ABOUT THE ROLE:

Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers.

The PBM Operations Associate is a member of the Rightway Data Operations team, reporting to the Manager, Data Operations. This role provides day-to-day support of eligibility, accumulator, and claims extract file feeds and data — ensuring files are received, processed, and delivered accurately and on time.

WHAT YOU’LL DO:

Support the execution of eligibility and accumulator file feeds and interfaces, from implementation through ongoing operations and maintenance.

Support claims extract file feeds, helping ensure data is accurate, complete, and delivered to external stakeholders on schedule.

Serve as a day-to-day resource for eligibility, accumulator, and claims extract data needs.

Collaborate with engineering, client success, implementations, benefit administration, and other internal stakeholders to ensure eligibility, accumulator, and claims extract functions operate in accordance with requirements.

Monitor downstream vendor feeds (e.g., ID card fulfillment) and third-party integrations (e.g., health plans, TPAs, medical vendors) to help ensure deliverables are met on time; escalate and assist in troubleshooting issues as they arise.

Perform research and support troubleshooting of day-to-day inquiries or issues related to eligibility, accumulators, and claims extract/data feeds.

Maintain accurate, up-to-date documentation of eligibility, accumulator, and claims extract processes and internal controls.

Additional responsibilities may be assigned as business needs evolve. Please note that during peak seasons, such as open enrollment and plan renewals, this role may require additional hours to help meet critical deadlines.

WHO YOU ARE:

Bachelor's degree preferred. Relevant experience considered for exceptional candidates.

2-4 years of experience in healthcare operations, PBM, health plan, or data/eligibility operations; entry-level candidates with strong analytical skills are encouraged to apply.

Detail-oriented, organized, strong sense of ownership, ability to work in a fast-paced environment with shifting priorities, comfortable learning new systems and platforms, consultative with internal and external stakeholders.

Working knowledge of Excel; ability to research and troubleshoot data discrepancies; eligibility, accumulator, or claims file feed experience.

COMPENSATION:  $65,000 - $85,000 annually, in addition to bonus and equity.

Compensation offered will be determined by geographic location, experience, and qualifications. CYBERSECURITY AWARENESS NOTICE

In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @ rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment. 

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our core values:

1. We are human, first Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.

2. We redefine what is possible We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.

3. We debate then commit We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.

4. We cultivate grit Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.

5. We seek to delight Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.

Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education. We foster an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis protected by applicable law. All employment decisions are based on merit, qualifications, need, and performance.