Personify Health адамдар мен ұйымдарға әл-ауқат, медициналық көмек және денсаулық сақтау жеңілдіктерін тиімдірек басқаруға көмектесетін жекелендірілген денсаулық сақтау шешімдерін әзірлейді. Оның платформасы жұмыс берушілерге, денсаулық сақтау жүйелеріне, медициналық сақтандыру жоспарларына және брокерлерге арналған әл-ауқатты қолдау навигациясын, медициналық көмекті басқаруды және денсаулық сақтау жоспарларын әкімшілендіруді біріктіреді. Компания медициналық көмекке қатысуды жеңілдетуге және ұйымдарға қызметкерлер денсаулығына салған инвестицияларын басқару мен жақсартуға көмектесуге бағытталған.
Senior Solutions Architect, PBM Operations — Arizona Remote
Senior Solutions Architect shaping PBM and TPA workflows for Personify Health’s personalized health platform. Leads data standards, vendor relationships, pricing, rebates, and operational performance.
Сипаттама
- Design end-to-end TPA workflows spanning eligibility, claims, billing, and benefit administration
- Convert unclear cross-functional operational needs into structured solution designs
- Document existing PBM systems and define future-state data flows and file exchanges
- Collaborate with Pharmacy Strategy on file formats, data exchange standards, and SLAs
- Lead PBM partner performance reviews and escalation processes
- Manage vendor onboarding from legal, data-sharing, and technical requirements through go-live
- Work with PBMs to shape product development for existing and prospective clients
- Create training materials for and educate Account Management, Implementation, and Tech Ops teams
- Track drug cost containment, PMPM performance, and vendor cost results
- Find opportunities to reduce costs
- Maintain pricing models and rebate guarantees
- Negotiate rebate and pricing contracts
- Give leaders visibility into TPA and PBM operational performance
- Present program performance during client reviews
- Create SOPs and documentation that support ongoing improvement
Талаптар
- At least seven years of experience in healthcare, TPA operations, product, systems architecture, implementation, or a related field
- Experience with PBM operations, data file formats, data dictionaries, and compliance requirements
- Experience with pharmaceutical rebate models, formulary management, and drug cost containment strategies
- Working knowledge of the legal and regulatory requirements for PBM operations and data sharing, including HIPAA and CMS
- Demonstrated ability to map complex processes and design end-to-end workflows
- Knowledge of data management systems and analytics tools
- Knowledge of PBM data file formats and data exchange standards
- Knowledge of rebate and pricing agreement structures
- Knowledge of tools for process documentation and SOP development
Артықшылықтар
- Competitive base salary
- Comprehensive medical and dental coverage through the company’s health solutions
- Unlimited paid time off
- Mental health support
- Retirement planning
- Financial protection
- Professional development with defined career progression and learning budgets
- Mission-driven culture that values diverse perspectives and meaningful impact
- Wellness programs
- Additional employee perks
- Full benefits package beginning on the first day