RxSense

Administration

• Own and lead the full implementation lifecycle for large, complex, or strategic clients from initiation through production deployment, ensuring all contractual deliverables are met on time and within scope.
• Serve as the primary benefits configuration expert on client implementations, leading all discovery, requirements gathering, and configuration sessions.
• Anticipate and proactively mitigate implementation risks; develop contingency plans and communicate issues to leadership with recommended solutions.
• Review and validate benefit set-ups performed by junior analysts prior to client go-live.
• Configure and maintain complex benefit designs, clinical rules, pharmacy networks, pricing structures, accumulators, and hierarchies across the RxSense platform.
• Develop deep expertise in RxSense claims platforms and serve as an internal resource for platform capabilities and limitations.
• Lead root-cause analysis on complex benefit set-up issues; develop and implement process changes to prevent recurrence.
• Conduct impact analysis for platform changes, client requests, and identified issues affecting benefit configurations.
• Build and sustain trusted advisor relationships with clients, serving as a consultative partner on benefit design strategy and platform optimization.
• Represent Benefits Administration in cross-functional meetings, client steering committees, and escalation calls.
• Partner with Client Services, Pharmacy Networks, UAT/QA, IT, Finance, and Clinical teams to drive flawless implementations and ongoing client satisfaction.
• Provide mentorship, training, and day-to-day guidance to Benefits Administration Analysts and other team members.
• Develop and deliver training materials for internal staff and private-label clients on benefit set-up requirements and platform best practices.
• Act as an escalation point for the team on complex or ambiguous benefit configuration challenges.
• Identify and lead initiatives to improve departmental workflows, documentation, and quality standards.
• Assist the Director in developing and maintaining department policies, procedures, and best practices.
• Contribute to strategic projects and product initiatives as a subject matter expert.

Senior Benefits Administration Analyst

Operations

• 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.

Formulary Operations Analyst

Data Analyst

• Interpret data, analyze results, and provide ongoing reports.
• Identify, analyze, and interpret trends or patterns in complex data sets.
• Work with business counterparts to understand the business context and requirements and apply them as a basis for the utilization and analysis of data.
• Gain a deep understanding of the data model, critical data entities and data elements in the data warehouse, data marts, and related databases.
• Acquire data from primary or secondary data sources for the purpose of analysis and reporting to business stakeholders.
• Build client facing output format and support automation for repeatable reports.
• Perform root cause analysis on data issues or anomalies, and communicate findings clearly.
• Contribute to developing scalable, self-service BI dashboard (e.g., in Qlik, or other BI tools).
• Collaborate cross-functionally to improve data pipelines, processes, and data governance.