Operations Specialist, Senior

In this role you will be a subject matter expert who will lead formulary implementation with the pharmacy claim adjudicator and other vendors to ensure maintenance, validation, and audits are compliant with business needs. This role is responsible for supporting day-to-day operations, maintaining of formulary and drug list databases, maintaining desk-level procedures as well as job aids, and creating reports. The Operations Specialist, Senior will collaborate cross functionally with the pharmacy claim adjudicator, analytics, benefits and claims, communications, compliance, prior authorization, and customer services departments to communicate formulary and utilization management changes, formulary configuration, and to ensure that formulary decisions are implemented in accordance with health plan client business rules and regulatory requirements.