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Salary: USD 65,000 - 85,000 / annual
Rightway is building a new pharmacy benefit management (PBM) platform focused on fairness, transparency, and unlocking the supply chain. As a PBM Operations Associate, you'll join the Operations team reporting to the Director of Claims & Data Operations, playing a critical role in configuring, testing, and maintaining benefits and claims adjudication rules.
Your responsibilities include reviewing client benefit design documentation for completeness and accuracy, then configuring those designs in the claims adjudication platform—including plan parameters, copay structures, inclusions/exclusions, and utilization management edits. You'll develop and execute test claim scenarios to validate benefit setups before go-live, perform ongoing monitoring and regression testing post-launch, and research/document any identified defects through resolution.
You'll research and resolve inquiries related to claims adjudication and benefit configuration, working cross-functionally with product, client success, implementation, and formulary teams to ensure benefits operate according to signed client requirements. You'll maintain complete, audit-ready documentation of benefit setup, testing evidence, and internal controls, and track work across implementation and plan change trackers to keep stakeholders informed of real-time status and deadlines.
The ideal candidate has 1–3 years of PBM experience in claims adjudication, benefit configuration, or testing/QA. A Bachelor's degree is preferred, though relevant experience is considered for exceptional candidates. Pharmacy Technician certification or related pharmacy experience is highly desirable. You'll need strong attention to detail, comfort navigating ambiguity and incomplete requirements, proficiency with structured tools (Excel, Smartsheet, claims platforms), and clear written communication skills.
