Formulary Operations Analyst

Summary

Join RxSense, a leading healthcare technology company, as a Formulary Analyst and play a key role in configuring, maintaining, and ensuring the quality of formularies within our platform. As a subject matter expert, you will support internal teams and external clients in executing accurate formulary strategies. This position demands strong technical skills, a deep understanding of pharmacy claims systems, and the ability to work independently on complex projects. You will be responsible for formulary configuration and maintenance, supporting implementations and enhancements, performing quality control and reporting, and collaborating with clients and teams. The role also involves leading or contributing to special projects and process improvements. RxSense offers a competitive salary and a supportive work environment.

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 — clear and concise with both internal and client-facing audiences
• Excellent organizational and time management skills
• Ability to take the lead on projects and follow through to completion
• Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data
• Self-starter with a proactive mindset and a high level of accountability

Responsibilities

• 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
• 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
• 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
• 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
• 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

Benefits

Salary Range: 75,000 - 85,000