PBM Compliance & Reporting Analyst

Full Time

Ind_Contributor

Requisition ID: 2102

The PBM Compliance & Reporting Analyst supports regulatory compliance, reporting operations, data validation, and audit readiness for the organization's pharmacy benefit management (PBM) programs. This role ensures accurate, complete, and timely federal and state regulatory filings while supporting compliance initiatives, process improvement, and documentation management.

Reporting to the PBM Compliance & Reporting Manager within Legal Operations, the Analyst partners closely with Legal, Pharmacy Operations, Data Operations, Informatics, IT, Account Management, Eligibility Vendors, and PBM partners. Success in this role requires strong analytical capabilities, exceptional attention to detail, excellent organizational skills, and the ability to manage multiple priorities in a fast-paced, highly regulated environment.

Essential Job Responsibilities Include:

• Support federal and state regulatory reporting, including CMS Section 111, CMS RxDC, All-Payer Claims Database (APCD), Department of Insurance (DOI) filings, DLR reporting, and other state-mandated pharmacy reporting requirements.

• Collect, prepare, validate, and submit data required for regulatory filings and renewals, and maintain reporting schedules to ensure deadlines are met.

• Maintain audit-ready documentation and support responses to DOI inquiries, audits, and regulatory reviews.

• Review and validate eligibility, demographic, accumulator, and claims data used in regulatory reporting; reconcile PBM and internal system data, investigate discrepancies, and document exceptions and resolutions.

• Monitor compliance workflows, maintain regulatory tracking logs and reporting inventories, and support internal and external audits by gathering supporting documentation.

• Use PBM Source and other internal systems to support regulatory reporting and compliance activities; create and manage Jira tickets and workflows, and track project status and stakeholder communications.

• Manage and triage the Compliance & Reporting shared mailbox and support submission activities within state DOI portals and CMS-related systems.

• Develop and maintain SOPs, Confluence pages, work instructions, and reporting guides to keep compliance documentation accurate, current, and audit-ready.

• Use Excel and other analytical tools to prepare and validate data files, support dashboards, KPIs, and compliance metrics, and analyze reporting trends to identify process improvements.

• Collaborate cross-functionally with Legal Operations, Data Operations, IT, Pharmacy Operations, Eligibility Vendors, and PBM partners, and communicate professionally with regulatory agencies and external partners as needed.

Required Skills / Experience:

• 1–3 years of experience in PBM operations, healthcare compliance, regulatory reporting, or data operations.

• Proficiency in Excel (VLOOKUP/XLOOKUP, Pivot Tables, data validation, reconciliation, and cleansing).

• Strong analytical, organizational, and communication skills; able to manage multiple projects and deadlines with high attention to detail.

Preferred Skills/Experience:

• Bachelor's degree preferred.

• Foundational knowledge of CMS reporting requirements (Section 111, RxDC) and state DOI reporting processes.

• PBM industry experience; experience with Jira, Confluence, or PBM Source; working knowledge of SQL, Python, SAS, or Snowflake; experience supporting audits or regulatory reviews.

Core Competencies:

• Regulatory Compliance • Data Analysis & Validation • Documentation Management • Audit Readiness • Process Improvement • Project Coordination • Critical Thinking • Communication & Collaboration • Attention to Detail

Based on relevant market data and other factors, the anticipated hiring range for this role is $62 ,400 to $78 ,000 annually. Final compensation rates will be determined based on various factors, including but not limited to experience, skills, knowledge, and internal equity considerations. This role is also short-term incentive eligible. Incentive amounts will vary by individual and business goals.

We are committed to fair and equitable compensation practices. The final salary offered to the selected candidate may vary from the posted range due to individual qualifications. Our goal is to ensure that all teammates are compensated fairly and competitively based on their contributions to our organization.

RxBenefits is also committed to providing best in class benefits to our teammates. We offer a robust total rewards package that includes:

• Remote first work environment

• Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members

• Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision)

• Additional buy-up options for Short- and Long-Term Disability and Life Insurance

• 401(k) with an employer match up to 3.5% available after 60 days

• Community Service Day to give back and support what you love in your community

• 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like

• Reimbursements for high-speed internet, we’ll send you a computer and monitors to help you do your best work

• Tuition Reimbursement for accredited degree programs

• Paid New Parent Leave that can be used for adoption or birth

• Pet insurance to protect your furbabies

• A robust mental health benefit and EAP service through Spring Health to support you when you need it most

RxBenefits provides equal opportunities for everyone who works for us and everyone who applies to join our team, without regard to sex or gender, gender identity, gender expression, age, race, religious creed, color, national origin, ancestry, pregnancy, physical or mental disability, medical condition, genetic information, marital status, sexual orientation, any service, past, present, or future, in the uniformed services of the United States (military or veteran status), or any other consideration protected by federal, state, or local law.