PBM Operations Specialist
Listed on 2026-02-07
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Healthcare
Overview
Waltz Health is looking for a thoughtful, detail-oriented, organized, passionate, and creative Benefit Analyst who can understand the strategic vision of our company and apply that understanding to help improve the healthcare experience and outcomes of patients. This role supports the implementation and maintenance of pharmacy adjudication plans, focusing on the Waltz Connect Product with an emphasis on the Specialty and GLP-1 opportunities as well as our ISP Integrated Savings Programs.
The ideal candidate combines a strong analytical and technical mindset with the ability to translate requirements into functional plan designs.
This role reports to our Vice President, Pharmacy Product Management, and collaborates with our Product Team, VP and SVP of Product, Chief Strategy Officer, Chief Information Officer, and Chief Technology Officer.
Responsibilities- Research, develop, test, evaluate, and document plan and benefit design
- Monitor and analyze data and procedures for claims processing
- Identify opportunities for improvement and develop new benefit reporting capabilities
- Serve as a benefit subject matter expert
- Research and resolve claims processing requests
- Review release notes for potential enhancements to configuration or plan capabilities
- Configure new features
- Develop expertise on the pharmacy industry, pain points, and opportunities to create value
- Use industry expertise to drive plan strategy and improve patient and end-user outcomes
- Create broad documentation to support the Waltz plan portfolio, including strategic business details and detailed technical materials
- Create, maintain, and socialize internal and external plan designs
- Incorporate feedback from internal and external customers on product strategy and expand market reach
In the first 90 days you will:
- Development, implementation, and plan maintenance processes
- Hear and understand the voice of the customer, identify internal and external customers, develop relationships and document needs
- Understand existing product processes and artifacts; identify problems and solution spaces to explore with product strategy
- Immersion in the landscape to identify problem and solution spaces
- Understand product quality and baseline metrics; identify opportunities to improve the quality of upcoming software releases
- Bachelor's degree
- Master's degree (bonus)
- 2+ years PBM/Pharmacy/Specialty or Mail Order pharmacy experience
- 2-3 years of Product management experience
- 1-2 years of Implementation/Integration experience
- Quality Assurance Testing experience (bonus)
- Plan Design, Quality Assurance Testing, Documentation, and advanced Microsoft Office skills (PowerPoint in particular)
- Pay Range: $60k - $80k annual salary
- Ground floor opportunity with one of the fastest-growing startups in health tech
- Competitive compensation with meaningful stock options
- Flexible vacation and a culture that supports recharging
- Medical, dental, vision, 401K, commuter benefits, and more
- Mid-Senior level
- Full-time
- Human Resources
- Hospitals and Health Care
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