PBM Analyst

PBM Analyst

Rightway is seeking four dynamic Analysts to join our growing COGS & Underwriting Strategy team. Each hire will support a specialized area Underwriting, Pricing, COGS, or Rebates contributing to data-driven strategies that enhance pricing accuracy, client value, and financial performance. This is an exciting opportunity for analytical professionals who thrive on problem-solving, collaboration, and financial modeling. Candidates will be considered for all four roles during the hiring process, and placement will be based on experience, technical skillset, and team alignment.

Depending on preferred placement, you may focus on one or more of the following areas :

• Execute financial and pricing models for client bids and renewals, interpreting results to identify key cost and performance drivers.
• Present underwriting analyses to internal stakeholders and refine offers to achieve optimal competitiveness.
• Perform detailed pharmacy claims analysis to identify and remedy variances in financial performance by recommending adjustments to pricing schedules.
• Conduct studies on novel pricing phenomena and industry trends to support market-leading innovative pricing strategies.
• Prepare and process client invoices, remittances, and billing files with accuracy and timeliness.
• Analyze pharmacy claims and administrative fee data to identify trends and ensure compliance with contractual terms.
• Interpret client contracts to extract billing requirements and flag variances impacting operational accuracy.
• Collaborate with Finance, Legal, and Operations teams to streamline billing processes and resolve discrepancies.
• Analyze pharmacy claims and rebate data to identify cost drivers, trends, and performance variances.
• Evaluate client-level rebate guarantees and forecasting models to support underwriting and renewals.
• Partner with Clinical and Formulary teams to assess the financial impact of formulary decisions and new drug launches.
• Support audit and internal control documentation, ensuring rebate data accuracy and transparency.
• Build and deliver PBM pricing analytics, such as copay modeling, formulary impact reports, and executive dashboards.
• Conduct studies on industry trends and regulatory changes to inform innovative pricing and market strategies.
• Maintain and validate critical datasets including drug lists, network data, and rebate or pricing structures.
• Participate in process improvement initiatives to enhance scalability, efficiency, and data integrity.

Who You Are :

Salary : $70,000-$100,000 / yr

Offer amounts for both remote and in office roles are influenced by geographic location.

In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @ rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment.

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient's care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $205mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We're headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

We're seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values :

Rightway is Proudly an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.