At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Manager of Benefit Plan Configuration is responsible for leading and developing the Benefit Plan Administration team across multiple lines of business to ensure accurate and consistent programming of benefit plans. This role ensures operational goals, performance guarantees, and service level agreements (SLAs) are achieved by managing team performance, creating project plans, and overseeing execution against deadlines. The position applies deep knowledge of departmental workflows to assess cross-functional impacts and collaborates with internal and external stakeholders, including customers, members, and providers, to resolve escalated issues and deliver high-quality service.

Responsibilities

• Manage employee performance through defined scorecards and performance metrics and provide ongoing feedback, coaching, direction, and development
• Lead the team in organizational data validation projects to support major system enhancements or release updates
• Oversee project management, programming, testing, and documentation activities to drive performance and ensure service level agreements (SLAs) are met or exceeded
• Schedule employees, manage capacity, and coordinate activities to maintain appropriate workflow
• Develop and document workflows, system requirements, system impact analyses, system design, process analyses, and testing, including reasonableness checks, using software development methodology to deliver efficient, cost-effective solutions as directed
• Identify reporting needs based on system programming and workflows; document reporting requirements and conduct testing of new reporting prior to implementation in production
• Create and maintain necessary functionality in ticketing systems, benefit landscapes, and workflows; recommend and implement solutions and evaluate results
• Partner with client-facing teams to resolve client concerns and ensure identified improvement opportunities are effectively addressed and implemented
• Other duties as assigned

Minimum Qualifications

• Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required

• 6 years of work experience in operations management, pharmacy benefit management, healthcare, insurance, retail, analytics, or operational compliance
• 2 years of leadership/people management experience

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Advanced analytical and problem-solving skills with demonstrated ability to evaluate operational workflows and identify cross-functional impacts
• Ability to lead teams through multiple, concurrent projects while ensuring compliance with strict timelines, SLAs, and performance guarantees
• Proficiency in Microsoft Excel, Word, and business systems used for benefit configuration, with the ability to translate data into actionable insights
• Demonstrated ability to develop and implement process improvements to drive efficiency and quality
• Strong interpersonal, communication, and facilitation skills with the ability to influence across internal and external stakeholders
• Ability to prepare and deliver documentation, reporting, and audit responses that ensure compliance with organizational and regulatory standards

Preferred Qualifications

• 3 years of people management experience in PBM environment
• Experience analyzing benefit plans and programming rules to demonstrate a benefit structure with an automated claims processing system

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.