Pharmacy Operations Specialist II – FWA

About the role

This remote, day‑shift position supports pharmacy program administration by ensuring accuracy and compliance across claims, formulary, benefit and network operations. The specialist will focus on pharmacy fraud, waste and abuse oversight, audit functions and partner with PBM and health‑plan teams.

Key responsibilities

• Support PBM oversight and internal activities related to pharmacy fraud, waste and abuse (FWA) and audit functions.
• Join PBM operational calls, follow up on open items and drive resolution.
• Implement and maintain compliant member and provider communication processes for FWA‑related matters.
• Partner with internal teams, health plans and PBM partners on regulatory reporting, operational metrics and network activities.
• Conduct data analysis, UAT and provide subject‑matter expertise for claims, formulary, benefit and network tasks.
• Ensure pharmacy documents are accurate, compliant and up‑to‑date.
• Support escalated issues, special projects and continuous process‑improvement initiatives.

Required profile

• High school diploma or GED; Bachelor’s degree preferred.
• 4+ years of pharmacy experience, including at least 1 year in managed‑care or PBM environments.
• Experience with Medicare and/or Medicaid programs is preferred.
• Current state Pharmacy Technician license preferred.
• Strong attention to detail, organizational and communication abilities.

Required skills

• Advanced Microsoft Excel.
• Power BI and/or Power Automate.
• Data analysis and reporting.
• Ability to conduct user‑acceptance testing (UAT).

What we offer

• Salary range $56,200 – $101,000 per year.
• Fully remote work with a standard Monday‑Friday schedule (start between 8:00 AM and 9:00 AM ET/CT).
• Opportunity to work within a large health‑care organization focused on improving member outcomes.