Pharmacy Design Consultant
Benecard Services, LLC, Florida, NY, United States
This role is responsible for the end‑to‑end development and ongoing maintenance of client Implementation Guides, which are essential for accurately configuring pharmacy benefits. The position requires expert‑level knowledge of prescription benefits, strong systems proficiency, and the ability to interpret complex plan design documentation from other carriers. Pharmacy Design Consultant will partner closely with internal teams and external stakeholders to ensure that all plan designs align with client expectations while adhering to regulatory requirements and system capabilities.
Key Responsibilities
Benefit Plan Design & Documentation
Lead the end‑to‑end creation, validation, loading and maintenance of pharmacy benefit plan designs/IG’s
Develop and maintain client Implementation Guides, ensuring accuracy, clarity, and alignment with benefit requirements
Translate complex client benefit requests into actionable system configurations within established capabilities
Provide guidance to cross‑functional teams, including Client Success, Operations, Compliance, and Operations
Recommend best practices for benefit design to ensure accuracy, efficiency, and consistency across clients
Quality Assurance, Testing & Monitoring
Provide support and 2nd set of eyes on all new client implementations testing
Cross‑Functional Collaboration & Support
Work closely with implementation teams to ensure smooth client onboarding and benefit transitions
Support internal teams with benefit interpretation questions and technical clarifications
Stay current on ACA requirements, state regulations, and clinical program capabilities
Maintain version control and auditability of Implementation Guides
Qualifications
Required
Minimum of 3‑5 years’ experience in pharmacy benefits, PBM operations or healthcare plan configuration
Proven ability to interpret plan design documents from external carriers
Knowledge of ACA mandates and state‑specific benefit rules
Strong time management and prioritization skills
Excellent communication and collaboration skills
Experience working cross‑functionally with implementation or client‑facing teams
Extremely detail‑oriented and organized
Preferred
Experience with benefit setup in a PBM system
Familiarity with health plan or TPA operations
Process improvement or documentation experience
Prescription claims adjudication experience
We are an Equal Opportunity employer.
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Key Responsibilities
Benefit Plan Design & Documentation
Lead the end‑to‑end creation, validation, loading and maintenance of pharmacy benefit plan designs/IG’s
Develop and maintain client Implementation Guides, ensuring accuracy, clarity, and alignment with benefit requirements
Translate complex client benefit requests into actionable system configurations within established capabilities
Provide guidance to cross‑functional teams, including Client Success, Operations, Compliance, and Operations
Recommend best practices for benefit design to ensure accuracy, efficiency, and consistency across clients
Quality Assurance, Testing & Monitoring
Provide support and 2nd set of eyes on all new client implementations testing
Cross‑Functional Collaboration & Support
Work closely with implementation teams to ensure smooth client onboarding and benefit transitions
Support internal teams with benefit interpretation questions and technical clarifications
Stay current on ACA requirements, state regulations, and clinical program capabilities
Maintain version control and auditability of Implementation Guides
Qualifications
Required
Minimum of 3‑5 years’ experience in pharmacy benefits, PBM operations or healthcare plan configuration
Proven ability to interpret plan design documents from external carriers
Knowledge of ACA mandates and state‑specific benefit rules
Strong time management and prioritization skills
Excellent communication and collaboration skills
Experience working cross‑functionally with implementation or client‑facing teams
Extremely detail‑oriented and organized
Preferred
Experience with benefit setup in a PBM system
Familiarity with health plan or TPA operations
Process improvement or documentation experience
Prescription claims adjudication experience
We are an Equal Opportunity employer.
#J-18808-Ljbffr