Director – Benefit Design and Requirements

AffirmedRx, a Public Benefit Corporation

Director of Benefit Design managing benefit strategies and client advisory within pharmacy benefit management firm. Leading a team and ensuring high-quality implementations and compliance standards.

Posted 6/26/2026full-timeRemote • Kentucky • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Serve as the senior PBM subject matter expert and strategic advisor to clients, consultants, and internal leadership across implementation and ongoing benefit strategy
Lead high-impact discovery and design sessions with clients, consultants, and cross-functional stakeholders to define complex benefit structures, including formulary strategy, cost-sharing models, accumulator logic, specialty tiers, step therapy protocols, and regulatory considerations
Shape and influence client benefit strategies by aligning industry best practices, market trends, and AffirmedRx platform capabilities
Anticipate risk and proactively address gaps in benefit design or documentation, partnering with senior implementation and account leadership to drive resolution
Provide executive-level oversight and guidance on benefit configuration, ensuring alignment between intended design and system build
Act as the escalation point for complex benefit design or configuration issues, driving resolution through deep expertise and cross-functional collaboration
Influence best practices for benefit setup within the adjudication platform, ensuring consistency, scalability, and accuracy
Lead and drive technology change initiatives related to adjudication systems and benefit capturing enhancements, partnering with IT and platform teams to evaluate, prioritize, and implement system improvements that reduce configuration error, improve accuracy, and scale with organizational growth
Own the testing strategy and validation framework for PBM benefits, ensuring comprehensive coverage of complex plan structures and edge cases
Oversee end-to-end testing validation, ensuring benefit logic, cost-share structures, accumulators, and compliance requirements function as designed
Drive cross-functional alignment during UAT cycles, ensuring efficient defect resolution and timely remediation
Provide executive summaries of go-live readiness, including risk assessments, issue tracking, and mitigation strategies
Ensure all implementations meet the highest standards of accuracy, compliance, and client expectations prior to go-live
Build and lead the Benefit Design & Requirements function, including defining team structure, hiring strategy, and capability roadmap
Hire, coach, and develop a high-performing team, establishing clear roles, expectations, and career progression pathways
Establish KPIs and performance metrics to measure quality, efficiency, and client outcomes
Drive continuous improvement initiatives based on implementation retrospectives, root cause analysis, and client feedback
Ensure all processes and documentation meet regulatory, audit, and contractual compliance requirements
Partner with senior leadership to align function priorities with broader organizational goals and growth strategy

Requirements

What you’ll need

No specific requirements listed.

Benefits

Comp & perks

To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes
To work in a culture where people thrive because when OUR team thrives, OUR business thrives
Competitive compensation, including health, dental, vision and other benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

benefit designformulary strategycost-sharing modelsaccumulator logicspecialty tiersstep therapy protocolsadjudication systemstesting strategyvalidation frameworkcompliance requirements

Soft Skills

strategic advisorcross-functional collaborationexecutive-level oversightinfluence best practicesrisk assessmentteam leadershipcoachingcontinuous improvementproblem-solvingcommunication