Formulary Operations Analyst

Remote (United States)

About the Role

A Formulary Operations Analyst is needed to support the configuration, maintenance, and quality assurance of formularies within a healthcare technology platform. This role is responsible for ensuring that formulary data is accurate, properly configured, and aligned with client requirements, clinical strategies, operational goals, and applicable regulatory requirements.

The ideal candidate has experience with formulary operations, pharmacy claims adjudication, or healthcare analytics and is comfortable working independently on detailed technical issues and complex projects. This position also serves as a subject matter expert for internal teams and external clients, helping translate clinical direction into accurate system configurations.

Employment Type: Full Time

Salary:$75,000 – $85,000 per year

What You’ll Do

• Formulary Configuration and Maintenance
  • Configure, update, and maintain standard and customized formularies within a claims adjudication system.
  • Ensure that formulary builds accurately reflect client requirements, clinical strategies, and regulatory guidelines.
  • Investigate adjudication issues, discrepancies, defects, and anomalies.
  • Perform detailed analysis to identify root causes and implement appropriate resolutions.
• Implementation and Enhancement Support
  • Participate in client implementations by gathering, documenting, and clarifying formulary requirements.
  • Serve as a subject matter expert for clinical capabilities and formulary-related processes.
  • Collaborate with internal teams to support the smooth integration of formulary solutions.
  • Contribute to platform enhancements that improve functionality and operational performance.
• Quality Control and Reporting
  • Conduct audits to confirm the accuracy of formulary configurations.
  • Monitor claims processing to proactively identify and resolve potential issues.
  • Analyze and present data related to formulary performance, disruptions, and operational trends.
  • Collect, organize, and aggregate data and reports for client meetings and formulary strategy presentations.
• Client and Team Collaboration
  • Respond to formulary-related questions from clients and internal stakeholders.
  • Assist with client training sessions as needed.
  • Work closely with clinical partners to convert clinical guidance into accurate system configurations.
  • Help develop and document internal workflows, best practices, and training materials.
• Special Projects and Process Improvements
  • Lead or contribute to special initiatives involving process optimization, disruption analysis, and platform enhancements.
  • Recommend and implement improvements that increase the accuracy, efficiency, and scalability of formulary operations.
  • Take ownership of assigned projects and follow through from planning to completion.

Qualifications

• Bachelor’s degree or at least one year of equivalent experience in healthcare or pharmacy benefit management.
• At least one year of experience in formulary operations, pharmacy claims adjudication, or a related healthcare analytics role.
• Demonstrated experience configuring and maintaining formulary data within claims systems.
• Strong working knowledge of formulary structures, Medispan or FDB data, and pharmacy benefit operations.
• Strong analytical and problem-solving skills, with the ability to turn findings into practical solutions.
• Excellent attention to detail and the ability to manage multiple priorities while meeting deadlines.
• Strong written and verbal communication skills, with the ability to communicate clearly with internal teams and clients.
• 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 the Microsoft Office Suite, including the ability to create complex documents and analyze data.
• Self-motivated and proactive, with a high level of accountability.