[Remote] Formulary Operations Analyst

Note The job is a remote job and is open to candidates in USA. RxSense is a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits. The Formulary Operations Analyst plays a key role in the configuration, maintenance, and quality assurance of formularies within the RxSense platform, supporting internal teams and external clients to execute accurate formulary strategies. Responsibilities 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 Skills 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 Company Overview RxSense is a health technology company provides IT solutions for flexible, efficient, and transparent pharmacy benefits administration. It was founded in 2015, and is headquartered in Boston, Massachusetts, USA, with a workforce of 201-500 employees. Its website is https//rxsense.com/. Company H1B Sponsorship RxSense has a track record of offering H1B sponsorships, with 2 in 2025, 3 in 2024, 4 in 2023, 1 in 2022, 5 in 2021, 10 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply To This Job