I have 3 years of experience working with PBM systems, including claims adjudication, formulary management, and prior authorization processes. I’ve collaborated with cross-functional teams to optimize system performance and ensure compliance with regulatory requirements.

I would conduct a thorough analysis of drug utilization, rebate opportunities, and generic substitution rates. By leveraging data analytics and benchmarking against industry standards, I’d identify cost-saving measures without compromising patient care.

In a previous role, I noticed inconsistent claim rejection rates. I investigated and traced the issue to a misconfigured edit in the PBM system. After coordinating with IT and the PBM, we corrected the edit, reducing rejections by 15%.

I subscribe to industry newsletters, attend webinars, and participate in professional organizations like AMCP. I also review FDA and CMS updates regularly to ensure our programs remain compliant and innovative.

I’m skilled in SQL for data extraction, Excel for analytics, and visualization tools like Tableau. I’ve also used PBM-specific platforms like Express Scripts’ EDI and Optum’s reporting suites to generate actionable insights.