Pharmacy Benefit Management Manager

POSITION SUMMARY

The Pharmacy Benefit Management (PBM) Operations Manager is a leadership role responsible for driving PBM strategy, execution, and innovation at Allied Benefit Systems. This individual will serve as the subject matter expert on PBM operations, industry trends, and compliance, while acting as the primary liaison between PBM vendors, internal teams, and external clients. The role supports sales and client services by analyzing data, providing consultative insights, and ensuring seamless integration of PBM solutions. As the leader of PBM initiatives, this person will oversee projects, enhance workflows, and ensure alignment with Allied’s broader data and operational ecosystem.

ESSENTIAL FUNCTIONS

• Lead all PBM-related initiatives, ensuring alignment with company goals and client needs.
• Act as the primary point of contact for PBM vendors and partners, managing relationships, performance, and escalations. Role might assist with additional Data Operations projects and ongoing managing.
• Support additional Data Operations projects and contribute to ongoing management activities.
• Support the Sales and Client Services teams by providing strategic insights, data analysis, and subject matter expertise during client meetings, RFPs, and renewals.
• Analyze PBM and pharmacy data to identify trends, cost drivers, and opportunities for improvement or savings.
• Collaborate with internal departments (Data Operations, Implementation, Compliance, Product, and IT) to ensure PBM workflows are integrated, efficient, and compliant.
• Respond to client and broker inquiries related to PBM services, benefits, and data, providing timely and accurate support.
• Stay current on PBM industry trends, regulatory changes, and compliance requirements, and communicate relevant updates to internal stakeholders.
• Lead and mentor a team of analysts or support staff involved in PBM operations and data management.
• Oversee the full data flow related to PBM files and ensure alignment with Allied’s broader EDI and data exchange processes.
• Continuously evaluate and enhance PBM-related processes, systems, and reporting tools to improve service delivery and operational efficiency.
• Share regular updates on PBM projects, performance metrics, and strategic initiatives in leadership and cross-functional meetings.

EDUCATION

Bachelor’s degree in healthcare administration, Business, Data Analytics, or a related field is preferred or equivalent work experience

EXPERIENCE AND SKILLS

• 5+ years of experience in PBM operations, healthcare data analytics, or pharmacy benefits strategy is required.
• Deep understanding of PBM structures, pricing models, compliance requirements, and industry trends.
• Strong analytical skills with the ability to interpret complex data and translate it into actionable insights.
• Experience working with EDI files (e.g., NCPDP, 834) and healthcare data workflows.
• Proven ability to manage vendor relationships and lead cross-functional initiatives.
• Excellent communication and presentation skills, with the ability to influence internal and external stakeholders.
• Proficient in Microsoft Office (especially Excel); experience with SQL or data visualization tools is a plus.
• Demonstrated leadership, project management, and team development capabilities.
• Ability to thrive in a fast-paced, evolving environment with a hands-on, collaborative approach.

POSITION COMPETENCIES

• Job Knowledge