Senior Pharmacy Performance & Operations Specialist (Pharmacy Benefits)

Location: Remote within the United States. Employees cannot be hired from U.S. territories or Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, or Maine. A dedicated home workspace and high-speed wired internet are required; hotspots, satellite, and wireless internet are not allowed.

Salary: $81,672–$103,320 USD target hiring range; maximum salary of $115,128 USD.

Company

hirify.global is a nonprofit member association providing health and dental benefits to federal employees, retirees, military retirees, and their families.

What you will do

• Oversee PBM contract performance, contractual guarantees, federal program requirements, and compliance obligations.
• Prepare, validate, and submit annual pharmacy benefit changes for FEHB and PSHB programs.
• Build reports, dashboards, and executive presentations using pharmacy performance data.
• Manage contractual credits, penalty letters, enforcement actions, issue escalation, and corrective action plans.
• Validate claims, monitor call center and eligibility trends, investigate member escalations, and improve operational performance.
• Act as the primary PBM liaison and coordinate cross-functional implementation and issue-resolution activities.

Requirements

• Bachelor’s degree in healthcare administration, pharmacy, business administration, public health, or a related field.
• At least five years of progressive experience in pharmacy operations, PBM, health plan operations, or federal health program administration.
• Knowledge of FEHB and PSHB pharmacy benefit requirements and regulatory expectations.
• Experience with Microsoft Office, performance reporting, dashboard development, trend analysis, contract interpretation, and problem solving.
• Strong communication, attention to detail, executive communication, and cross-functional collaboration skills.
• Must work remotely from an eligible U.S. location and maintain a dedicated workspace that protects PHI/HIPAA information.

Nice to have

• Advanced degree such as MPH, MHA, MBA, or PharmD.
• Experience with Tableau, Power BI, or similar data visualization tools.
• PMP, CAPM, or equivalent project management certification.
• Experience with OPM, CMS, or other federal oversight bodies.
• Lean, Six Sigma, or similar process improvement training.

Culture & Benefits

• Remote work with home-office requirements including minimum 30 Mbps download, 5 Mbps upload, and latency below 80 ms.
• Health, vision, and dental benefits effective on the first day.
• 401(k) plan with dollar-for-dollar matching up to 4% and a 6% annual company contribution.
• Paid time off, personal community enrichment time, incentive plan, and employee well-being program.
• Company-provided life, accidental death and dismemberment, short-term disability, and long-term disability coverage.
• Tuition assistance program.