Formulary Operations Analyst

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 potential issues proactively.
• Assist in analyzing and presenting data related to formulary performance or disruptions.
• Pull, organize, and aggregate data and reports to support client meetings and formulary strategy presentations.

Client and Team Collaboration

• Support client interactions as needed, including responding to formulary-related inquiries and assisting in training sessions.
• Work closely with clinical partners to ensure translation of clinical direction into accurate system configuration.
• Contribute to development and documentation of internal workflows, best practices, and training materials.

Special Projects and Process Improvements

• Lead or contribute to special initiatives such as process optimization, disruption analyses, or platform enhancements.
• Recommend and implement improvements to ensure greater accuracy, efficiency, and scalability of formulary operations.

Education/Experience

• 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.