Formulary Operations Analyst

Job Description

RxSense is seeking a Formulary Operations Analyst to play a key role in the configuration, maintenance, and quality assurance of formularies within the RxSense platform. The Analyst will act as a subject matter expert, supporting 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.

The role involves:

• Configuring, updating, and maintaining custom and standard formularies within the claims adjudication system.
• Troubleshooting adjudication issues and discrepancies.
• Participating in client implementations by gathering and documenting formulary requirements.
• Performing audits to validate formulary configuration accuracy.
• Supporting client interactions and assisting in training sessions.
• Contributing to the development and documentation of internal workflows, best practices, and training materials.
• Leading or contributing to special initiatives such as process optimization or platform enhancements.

Requirements:

• Bachelor’s degree or 1 year equivalent experience in healthcare (PBM).
• 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.
• Strong 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.
• Excellent organizational and time management skills.
• Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite.
• Self-starter with a proactive mindset and a high level of accountability.

RxSense offers:

• A salary range of $75,000 - $85,000.