Pricing Operations Analyst Job ID: 35350-50-221-001 (Remote)

Published date Posted on Indeed on Sep 16, 2021 (39 d ago)


  • Execute the MAC appeal process by consolidating data, researching industry pricing, and evaluating research and pricing proposals for appropriateness, accuracy, and impact
  • Update MAC lists in adjudication system and provide quality assurance of other system changes as necessary
  • Assist with preparation and maintenance of generic pricing throughout the MAC list across all lines of business
  • Complete mail order pricing reports to determine the usefulness of rates and margins
  • Report on discount card performance such as changes in product utilization, volume, discount rates, usual and customary rates and market share
  • Estimate the impact of weekly price changes as well as periodic changes to manufacturer contracts
  • Provide support as needed on relevant MAC processes and projects
  • Establish, maintain and support automated systems and processes
  • Generalize data structures and processes to facilitate improvements to efficiency through automation
  • Verify that claims performance adheres to the effective rate strategy and examine deviations from the target rate and prepare adjustments when necessary
  • Research industry trends on pricing, brand to generic changes, bio-similar product releases and Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) decisions
  • Monitor drug shortages and potential price increases to generate cost savings and avoid potential financial liability
  • Create, maintain, and distribute shortage reports to the appropriate parties
  • Monitor new generic drug entrance and changes in availability to create and update pricing based on changing market conditions
  • Perform effective rate reporting for executive management to ensure that both corporate goals and contractual obligations are met
  • Respond to pricing inquiries from business partners in a timely manner
  • Assess and validate claim adjudication setups by pharmacy and by client and investigate sources of discrepancies
  • Review and prepare claims data uploads for external auditors
  • Conduct special studies and investigations and report findings to department leaders
  • Other duties as assigned


  • Bachelor’s degree in business, mathematical, statistical, financial, or applied science discipline strongly preferred; proven industry experience will be acceptable in lieu of degree
  • Minimum 1 to 2 years’ relevant pricing or finance experience, preferably with a PBM
  • Financial and statistical reporting knowledge and experience
  • Effective verbal and written communication skills
  • A decisive individual who possesses a detail oriented perspective
  • A strategic planner with sound technical skills, analytical ability, good judgment and strong operational focus
  • Ability to work with peers in a team effort
  • Demonstrated ability to manage multiple priorities and deadlines
  • Capability to efficiently complete tasks in a fast paced environment
  • Ability to work extended hours, weekends and holidays pursuant with industry demands
  • Proficient in Microsoft Office and industry related software programs


  • A knowledgeable individual with appropriate industry experience, preferably in the healthcare, insurance or PBM industry
  • MS Access, VBA, or SQL programming knowledge and experience


Includes both a typical office environment, with minimal exposure to excessive noise or adverse environmental issues, and occasional local and/or overnight travel, including exposure to heat, cold, and inclement weather conditions. Mode of transportation for travel typically will include automobile and plane.


Ability to sit for prolonged periods of time


  • 1 year(s): Minimum 1 to 2 years��� relevant pricing or finance experience, preferably with a PBM


  • Bachelors or better in Finance or related field
  • Bachelors or better in Statistics or related field
  • Bachelors or better in Mathematics or related field
  • Bachelors or better in Business Economics or related field


  • Thought Provoking: Capable of making others think deeply on a subject
  • Team Player: Works well as a member of a group
  • Loyal: Shows firm and constant support to a cause
  • Innovative: Consistently introduces new ideas and demonstrates original thinking
  • Functional Expert: Considered a thought leader on a subject
  • Enthusiastic: Shows intense and eager enjoyment and interest
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
  • Dedicated: Devoted to a task or purpose with loyalty or integrity


  • Self-Starter: Inspired to perform without outside help
  • Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
  • Goal Completion: Inspired to perform well by the completion of tasks
  • Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals
  • Financial: Inspired to perform well by monetary reimbursement
  • Entrepreneurial Spirit: Inspired to perform well by an ability to drive new ventures within the business
  • Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor���s legal duty to furnish information. 41 CFR 60-1.35(c)

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