PBM Operations Specialist
Posted on November 01, 2025 (about 3 hours ago)
Waltz Health is a Chicago-based technology startup leading a new way forward for prescription care. They are innovating the pharmaceutical supply chain with AI-driven marketplaces and consumer tools to lower costs and improve experiences. Their vision includes better pricing and smarter tools to empower consumers and payers.
Waltz Health Values
The company's core values include:
- Integrity: Commitment to protecting clinical care value and honesty with partners.
- Inclusion: Advocating for a collaborative and diverse healthcare system.
- Access: Breaking down barriers for better prescription care choices.
- Accountability: Delivering quality work and bold outcomes.
- Progress: Driving innovation in pharmaceutical care.
Job Description
The PBM Operations Specialist will support the Waltz Connect Product, focusing on Specialty and GLP-1 opportunities and Integrated Savings Programs. Responsibilities include implementing and maintaining pharmacy adjudication plans, researching, testing, and documenting plan designs, monitoring claims processing, and driving plan strategy to improve patient outcomes. The role involves collaboration with product leadership and requires a strong analytical and technical mindset with stakeholder management skills.
Primary tasks include:
- Research, develop, test, and document plan and benefit design.
- Monitor and analyze claims processing data and procedures.
- Identify improvements and develop benefit reporting capabilities.
- Serve as a benefit subject matter expert.
- Resolve claims processing requests.
- Review release notes for enhancements and configure new features.
- Develop pharmacy industry expertise and drive plan strategy.
- Create and maintain documentation and socialize plan design internally and externally.
- Incorporate customer feedback to expand market reach.
Within the first 90 days, the specialist will:
- Develop implementation and maintenance processes.
- Understand the voice of customers and document needs.
- Learn existing product processes and identify areas for strategic exploration.
- Immerse in the healthcare landscape and identify improvement opportunities.
- Focus on product quality and metrics to improve software releases.
Success factors include experience in PBM and pharmacy benefits management, specialty and retail pharmacy knowledge, task prioritization, QA and software testing, backlog management, requirements gathering, stakeholder communication, and proficiency in Microsoft Office with strong PowerPoint skills.
Preferred qualifications include a bachelor's degree, master's degree as a bonus, 2+ years in PBM/pharmacy/specialty or mail order pharmacy, 2-3 years product management experience, and 1-2 years implementation/integration experience.
Compensation and Benefits
The pay range is $60,000 to $80,000 annually. Benefits for full-time employees include ground-floor startup opportunity, competitive compensation with stock options, flexible vacation, medical, dental, vision, 401K, commuter benefits, and more.
To apply for the PBM Operations Specialist position at Waltz Health, please use the application form on the job posting page. You will need to provide your first and last name, email, phone number, resume/CV, cover letter, education details, LinkedIn profile, and other necessary information requested in the form. Ensure all required fields marked with an asterisk (*) are completed.
Application Process
The application includes details about your experience in specialty pharmacy operations, contracting, software development, willingness to travel, how you heard about Waltz Health, ideal start date, expected salary, current residence, work authorization, and background check agreement.
Submit your application through the provided submission button on the page.