RxSense
healthcare technology
FormularyOperationsAnalyst
Neural analysis suggests this role is
optimal for Mid candidates.
“Formulary Operations Analyst at RxSense. Skills: Formulary Operations, Pharmacy Claims, Data Analysis. Configure, update, and maintain formularies. Ensure accuracy and alignment of formulary builds”
What You'll Achieve.
improve the management and access of cost-effective pharmacy benefits; simplify their businesses; save on prescriptions; transform their business performance; optimize their innovative models; ensure accuracy and alignment of formulary builds; resolve defects and anomalies; ensure smooth integration of formulary solutions; validate formulary configuration accuracy; detect and correct potential issues proactively; support client meetings and formulary strategy presentations; ensure greater accuracy, efficiency, and scalability
Industry & Context.
problem-solving skills; analyze data and translate findings into actionable solutions; Troubleshoot adjudication issues; Conduct detailed analysis to resolve defects and anomalies
What They're Looking For.
Must Have
1+ year's of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics, Demonstrated expertise in configuring and maintaining formulary data within claims systems, Excellent working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations, problem-solving skills with the ability to analyze data and translate findings into actionable solutions, Detail-oriented, with the ability to manage multiple priorities and meet deadlines, Superior written and verbal communication skills — clear and concise with both internal and client-facing audiences, Excellent organizational and time management skills, Ability to take the lead on projects and follow through to completion, Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data, Self-starter with a proactive mindset and a high level of accountability
What You'll Do.
and maintain formularies
Ensure accuracy and alignment of formulary builds
Troubleshoot adjudication issues and analyze defects
Participate in client implementations
Gather and document formulary requirements
Serve as a clinical capabilities subject matter expert
Perform audits to validate formulary configuration
Monitor claim processing for issues
Analyze and present data related to formulary performance
and aggregate data and reports
Support client interactions and inquiries
Assist in training sessions
Contribute to development of internal workflows
Recommend and implement improvements
How You'll Work.
Team & Collaboration
Collaborate with internal teams; Support client interactions; Work closely with clinical partners; Contribute to development of training materials
Communication Scope
Superior written and verbal communication skills; clear and concise with both internal and client-facing audiences
Process & Methodology
Lead or contribute to special initiatives, Manage multiple priorities, Follow through to completion
Full Job Description
We are a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits. Our technology helps enterprise and partnership clients simplify their businesses and helps consumers save on prescriptions. As a leader in SaaS technology for healthcare, we offer innovative solutions with integrated intelligence on a single enterprise platform that connects the pharmacy ecosystem. With our expertise and modern, modular platform, our partners use real-time data to transform their business performance and optimize their innovative models in the marketplace. Position Summary: The Formulary Analyst plays a key role in the configuration, maintenance, and quality assurance of formularies within the RxSense platform. Acting as a subject matter expert, the Analyst supports both internal teams and external clients in executing accurate formulary strategies and ensuring alignment with clinical and operational goals. This position requires strong technical proficiency, a deep understanding of pharmacy claims systems, and the ability to work independently on complex issues and projects. Essential Duties and Responsibilities: Formulary Configuration and Maintenance Configure, update, and maintain custom and standard formularies within the claims adjudication system. Ensure accuracy and alignment of formulary builds with client intent, clinical strategy, and regulatory requirements. Troubleshoot adjudication issues and discrepancies; conduct detailed analysis to resolve defects and anomalies. Support for Implementations and Enhancements Participate in client implementations by gathering and documenting formulary requirements. Serve as a clinical capabilities subject matter expert. Collaborate with internal teams to ensure smooth integration of formulary solutions. Quality Control and Reporting Perform audits to validate formulary configuration accuracy. Monitor claim processing to detect and correct potentia
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