Pharmacy Test Implementation Lead

About the role

The Pharmacy Test Implementation Lead is responsible for developing and executing test plans for drug lists, pharmacy benefits, and medical components across all business lines, ensuring accurate coding on the PBM adjudication platform.

Key responsibilities

• Design and coordinate test plans aligned with implementation work‑plans and management validation.
• Create, upload, and analyze test files, run automated test exercises on the PBM platform, and reconcile results.
• Report coding errors and findings to specialists and PBM teams, and follow up to ensure corrections.
• Validate Benefit Specification Forms and Benefit Change Forms to ensure accurate coding of formularies, benefits, and special drug lists.
• Participate in audits and regulatory reviews, providing detailed test results and supporting corrective action plans.

Required profile

• Bachelor’s degree in Natural Sciences, Pharmacy or a related field (preferred).
• Minimum five years of experience coding benefits, forms, or medical claims in a PBM or healthcare insurance environment.
• Advanced proficiency in Excel.
• Spanish – advanced and English – intermediate communication skills.