Formulary Operations Analyst

RxSense

Formulary Analyst managing the configuration and quality assurance of formularies within the RxSense platform. Collaborating with teams to ensure accurate formulary strategies aligned with goals.

Posted 5/29/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $75,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account RxSense Website LinkedIn All Job Openings 201 - 500 employees ⚕️ Healthcare Insurance 💊 Pharmaceuticals ☁️ SaaS 💰 Private Equity Round on 2020-05 Healthcare Insurance
Pharmaceuticals
SaaS RxSense is a HealthTech company dedicated to modernizing pharmacy benefit management. They develop cutting-edge products that optimize claims adjudication and analysis, aiming to lower costs and improve access within the pharmacy ecosystem. RxSense offers solutions for PBMs, pharmacies, pharma manufacturers, payers, and consumers, supporting better outcomes for millions of people daily. Their products include advanced tools like the RxIQ Enterprise adjudication engine, business intelligence analytics platform, and AI-based pricing optimization. They are known for their flagship prescription savings brand, SingleCare, which helps consumers secure affordable prices while benefiting pharmacy partners. Formulary Operations Analyst Job not on LinkedIn 🔥 28 minutes ago 🇺🇸 United States – Remote 💵 $75k - $85k / year ⏰ Full Time 🟢 Junior ⚙️ Operations 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
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. 🎯 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. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Internal Operations Assistant 🔥 13 hours ago Little Sleepies 11 - 50 Website LinkedIn All Job Openings Customer Support Operations specialist for a fast-growing children's company. Managing fraud prevention, customer experience, and internal operations within a remote team environment. 🇺🇸 United States – Remote 💵 $21 - $25 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level ⚙️ Operations 🚫👨‍🎓 No degree required Operations Administrator 🔥 13 hours ago GoHealth Urgent Care 1001 - 5000 ⚕️ Healthcare Insurance 📡 Telecommunications Website LinkedIn All Job Openings Operations Administrator coordinating and executing daily operations in a health care setting at Northwell-GoHealth. Partnering with leadership and managing scheduling, payroll, and onboarding processes. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior ⚙️ Operations 🚫👨‍🎓 No degree required Patient Access Specialist II – Practice Operations 🔥 18 hours ago University of Maryland Faculty Physicians 1001 - 5000 📚 Education 🧘 Wellness Website LinkedIn All Job Openings Patient Access Specialist scheduling medical exams and appointments for healthcare providers. Responding to patient inquiries and managing high volume appointment requests efficiently. 🇺🇸 United States – Remote 💵 $18 - $28 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level ⚙️ Operations 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Analyst, Technology Operations, Government Programs 🔥 22 hours ago Navitus Health Solutions 1001 - 5000 ⚕️ Healthcare Insurance 💊 Pharmaceuticals 🤝 B2B Website LinkedIn All Job Openings Analyst in Tech Operations for Government Programs at Navitus Health Solutions. Responsible for executing processes accurately, efficiently, and in compliance with CMS regulations. 🇺🇸 United States – Remote 💵 $43.8k - $52.1k / year ⏰ Full Time 🟢 Junior ⚙️ Operations Payment Operations Specialist 🔥 23 hours ago TrueML 51 - 200 💳 Fintech 💸 Finance 👥 B2C Website LinkedIn All Job Openings Payment Operations Specialist ensuring secure flow of electronic payment transactions for a mission-driven financial software company. Responsible for operational execution, monitoring, and compliance. 🇺🇸 United States – Remote 💵 $80k - $120k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level ⚙️ Operations View More Operations Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

formulary operationspharmacy claims adjudicationconfiguring formulary datadata analysisprocess optimizationdisruption analysisformulary configuration accuracyclinical strategy alignmentregulatory compliancedata aggregation

Soft Skills

problem-solvingdetail-orientedorganizational skillstime managementcommunication skillsproject leadershipproactive mindsetaccountabilitycollaborationclient interaction

Certifications

Bachelor's degree in healthcare