PBM Operations Specialist
Posted on October 02, 2025 (21 days ago)
Waltz Health, a Chicago-based technology startup, is revolutionizing prescription care by rethinking the pharmaceutical supply chain. They implement AI-driven marketplaces to reduce costs and provide consumer tools to guide care decisions. Their technology aims to lower costs, empower consumers, and help payers control pharmacy benefits for improved healthcare outcomes.
Waltz Health Values
- Integrity: Committed to protecting clinical care value and honesty with partners.
- Inclusion: Advocates for a collaborative, diverse system embracing unique perspectives.
- Access: Focused on removing barriers to provide affordable, appropriate prescription care.
- Accountability: Owns quality work and outcomes to deliver excellent partner experiences.
- Progress: Drives healthcare innovation and improvement continuously.
Job Description
Waltz Health seeks a detail-oriented, organized, and passionate PBM Operations Specialist to enhance healthcare experiences by implementing and maintaining pharmacy adjudication plans. The role supports the Waltz Connect Product, focusing on Specialty and GLP-1 opportunities and ISP Integrated Savings Programs. Success requires curiosity, learning eagerness, industry and functional expertise, strong analytical skills, and the ability to translate requirements into functional plan designs.
The specialist will collaborate with the Product Team, VP and SVP of Product, Chief Strategy Officer, and Chief Technology Officer, reporting to the Vice President of Pharmacy Product Management.
Primary responsibilities:
- Research, develop, test, evaluate, and document plan and benefit design.
- Monitor and analyze claims processing data and procedures.
- Identify improvement opportunities and develop new benefit reporting capabilities.
- Act as a benefit subject matter expert.
- Research and resolve claims processing requests.
- Review release notes for configuration or plan enhancements.
- Configure new features and develop pharmacy industry expertise.
- Drive plan strategy and improve patient and user outcomes.
- Create comprehensive documentation supporting the Waltz plan portfolio.
- Create, maintain, and socialize internal and external plan design.
- Incorporate feedback to expand product strategy and market reach.
First 90 days goals:
- Develop implementation and plan maintenance process.
- Understand customer needs and document opportunities.
- Learn existing product processes and identify improvement areas.
- Immerse in the landscape and product strategy.
- Understand product quality and identify software release improvement opportunities.
Required traits and skills:
- PBM Pharmacy Benefit Management experience with clients, benefit plans, formulary management, prior authorization, and claims.
- Specialty and Retail Pharmacy experience.
- Task management and prioritization abilities.
- Quality assurance and software testing experience.
- Backlog management.
- Requirements gathering, documentation, and stakeholder communication skills.
- Proficiency in Microsoft Office, especially PowerPoint.
Preferred qualifications:
- Bachelor's degree required, Master's is a bonus.
- 2+ years of PBM/Pharmacy/Specialty or Mail Order pharmacy experience.
- 2-3 years of Product management experience.
- 1-2 years of Implementation/Integration experience.
Pay Range
$60k - $80k Annual salary
Benefits for Full-Time Employees
- Ground floor opportunity with a fast-growing health tech startup.
- Competitive compensation including meaningful stock options.
- Flexible vacation and a culture supporting time to recharge.
- Medical, dental, vision, 401K, commuter benefits, and more.
Apply for this job by visiting the Waltz Health job board website through the specific job posting page link: https://job-boards.greenhouse.io/waltzhealth/jobs/5654550004. You will find an application form on the page to fill out and submit your details including your resume/CV and cover letter.
Application Process
Submit required information including:* First Name, Last Name, Email, Phone, Resume/CV, and Cover Letter. Indicate your qualifications, experiences, and other requested information.
Follow instructions on the application form and submit your application online through the provided tools.