Benefit Configuration Specialist (Medtech)

TL;DR

Benefit Configuration Specialist (Medtech): Supporting the testing and validation of pharmacy benefit plan configurations across multiple lines of business with an accent on aligning with client intent, regulatory requirements, and internal configuration standards. Focus on performing scenario-based testing, identifying configuration discrepancies, and collaborating with cross-functional teams to resolve issues.

Location: Remote (For Non-Local) or Hybrid (Local to New York, NY or Denver, CO area)

Salary: $75,000 - $90,000 USD

Company

hirify.global is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans.

What you will do

• Execute end-to-end testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business.
• Perform detailed implementation audits to ensure benefit setup aligns with client intent, regulatory requirements, and internal configuration standards.
• Analyze claim outputs to confirm expected adjudication behavior and accumulator movement.
• Identify, document, and communicate configuration discrepancies or defects; collaborate with configuration team to ensure timely resolution.
• Participate in client-facing meetings to review testing scope, discuss audit findings, clarify benefit intent, and provide detailed explanations of testing results and configuration outcomes.
• Contribute to process improvements that enhance testing efficiency, audit quality, and overall benefit validation standards.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent work experience).
• Minimum 3–5 years of experience in pharmacy benefit management (PBM), health plan operations, or benefit configuration.
• Direct experience supporting Medicare lines of business (Medicare Part D and/or MAPD).
• Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic.
• Strong analytical skills with high attention to detail and accuracy.
• Strong written and verbal communication skills with ability to clearly document findings and discrepancies.

Culture & Benefits

• Full-time and part-time benefit-eligible employees can elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts.
• Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents.
• Full-time employees receive basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program at no cost.
• Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment.