PBM Operations Associate (Healthcare)

Location: Remote

Salary: $65,000–$85,000 per year. Compensation depends on geographic location, experience, and qualifications.

Company

hirify.global is a healthcare technology company that helps patients find better care and medications through a mobile app, clinician and pharmacist support, and pharmacy benefit management services.

What you will do

• Review client benefit design documentation, identify gaps, and coordinate resolutions with implementation and client success teams.
• Configure plan parameters, copay structures, inclusions, exclusions, and utilization management edits in the claims adjudication platform.
• Develop and execute test claim scenarios, perform regression testing, and investigate and resolve configuration defects.
• Research claims adjudication and benefit configuration inquiries and communicate findings and remediation steps.
• Collaborate with product, client success, implementation, and formulary teams to deliver benefits according to signed client requirements.
• Maintain audit-ready documentation and keep implementation and plan-change trackers current.

Requirements

• Bachelor’s degree preferred; relevant experience may be considered.
• 1–3 years of experience in PBM claims adjudication, benefit configuration, or testing/QA.
• Strong attention to detail and the ability to trace claim outcomes to configuration drivers.
• Ability to work with incomplete requirements, ask clarifying questions, and exercise sound judgment.
• Comfort with Excel, Smartsheet, claims platforms, multiple client deliverables, and firm deadlines.
• Clear written communication and consistent documentation of decisions and stakeholder updates.

Nice to have

• Pharmacy Technician certification or related pharmacy experience.

Culture & Benefits

• Remote work environment.
• Core values include putting people first, redefining what is possible, debating then committing, cultivating grit, and seeking to delight.
• Opportunity to support a new pharmacy benefit management model focused on fairness, transparency, supply-chain access, physician-patient relationships, and consumer navigation.