About this role.
This Benefits Configuration Analyst role supports pharmacy benefit plan implementation, configuration, quality assurance, and ongoing operations within a PBM technology environment. The analyst will translate client plan requirements into accurate platform configurations, maintain prior authorization and step-therapy rules, and manage formulary updates. Key operational duties include claims-adjudication troubleshooting, go-live testing, post-launch audits, and resolution of benefit-related inquiries with member support and customer success teams. The position requires at least four years of payer, claims, and benefit-configuration experience, strong Excel and analytical skills, and clear cross-functional communication.
Role DNA
A quick view of the complexity, pace, ownership and collaboration implied by the job description.
Job Complexity
4/5Pace & Pressure
4/5Autonomy Level
4/5Communication Load
4/5Salary analysis
Estimated compensation compared with the broader US market for similar roles.
Core skills
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Sample interview questions
I begin by documenting requirements in a structured configuration matrix, including eligibility, copays, deductibles, formularies, prior authorization, step therapy, and exceptions. I validate ambiguous rules with the client and internal clinical or implementation stakeholders, configure the plan using controlled documentation, and complete peer review and test-case validation before launch.
I would first reproduce the claim using the member, drug, pharmacy, and date-of-service details, then compare the result with the approved benefit design and effective-dated configuration. I would review formulary status, accumulators, network rules, prior authorization, and step-therapy logic, identify the root cause, correct it through the appropriate change-control process, and verify the fix with regression testing.
I would use standardized build templates, version-controlled requirement documents, effective-date checks, peer review, and reconciliation reports between approved plan documents and system configuration. I would also perform pre-go-live scenario testing, post-go-live audits, and periodic monitoring for configuration exceptions or inconsistent plan structures.
I assess urgency by member impact, financial or compliance risk, client go-live dates, and operational dependencies. Member-access and claim-processing issues receive immediate attention, while lower-risk enhancements are documented and scheduled transparently; I communicate status, ownership, risks, and escalation needs to affected stakeholders throughout.
I would examine recurring defects, rework reasons, and implementation cycle times to identify patterns such as incomplete requirements or inconsistent testing. For example, I might introduce a required configuration checklist and reusable test library for common benefit designs, measure defect rates before and after adoption, and refine the process with feedback from operations and implementation teams.
Who We Are:
SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.
We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:
- Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
- Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
- Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.
Job Summary:
As a Benefits Configuration Analyst, you will support cross-functional teams during implementations and build and manage pharmacy benefit plans on various platforms to ensure a high quality SmithRx product. This role will also be responsible for supporting the Plan Operations team with core benefits operations functions while building and maintaining accurate benefit configuration.
What will you do:
- Work with clients, identifying and understanding benefit plan requirements. Build and maintain pharmacy benefit plans for client groups.
- Aid in the organization of benefit configuration and structure for the accounts assigned by monitoring plan data integrity.
- Assist in determining process improvement efforts.
- Maintain prior authorizations and step therapy rules.
- Grandfather/transition new clients and update formularies with changes at the direction of the clinical team.
- Communicate project status, escalating issues when appropriate. Provide insight into changes to improve workflow efficiency.
- Collaborate with member support and customer success teams to review and resolve inquiries related to benefits timely to improve member experience.
- Provide troubleshooting support for our claims adjudication process.
- Support new client implementations, conduct go-live testing, perform post go-live auditing and support to ensure plans are configured to confirm accuracy.
What you will bring to SmithRx:
- 4+ years of experience in payer/claims and benefit configuration required
- Analytical skills; Microsoft Excel skills;
- Strong communication skills via face-to-face meetings, conference calls and written correspondence
- Self-starter mentality: ability to make informed decisions, find creative approaches to difficult challenges, and deliver on commitments
- Execution-focused ethos – you are a solutions-oriented problem solver and efficiency driven
- Flexible, dependable, adaptable, and able to respond under the pressure of a fast-paced technology company
What SmithRx Offers You:
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- Paid Company Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities
Zone A includes the following locations:
- San Francisco Bay Area – California
- Metro New York City – Connecticut, New Jersey, New York and Pennsylvania
Zone A Pay Range
$66,300—$78,000 USD
Zone B includes the following locations:
- California – outside of San Francisco Bay Area
- Metro Denver / Boulder – Colorado
- Metro District of Columbia – District of Columbia, Maryland, Virginia and West Virginia
- Metro Boston / Cambridge – Massachusetts and New Hampshire
- Metro Austin – Texas
- Metro Seattle – Washington
Zone B Pay Range
$60,800—$71,500 USD
Zone C includes all other locations not listed above, including:
- Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Wisconsin, Wyoming
- Non metro Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Virginia, Washington, and West Virginia
Zone C Pay Range
$55,300—$65,000 USD
Compensation & Benefits
- Base Salary: The range listed above reflects our standard pay scale and actual pay will vary based on work location, job level, job-related knowledge, skills, and experience.
- Total Rewards: In addition to base pay, this role may be eligible for bonuses, commissions, or equity. SmithRx offers a variety of benefits to help you live well, including: time off programs, medical, dental, vision, mental health support, paid parental leave, life and disability insurance and 401(k).
Individual offers are tailored to your geography, experience, skills, and education. Your recruiter can share more specific details during the hiring process. In the meantime, feel free to explore our comprehensive benefits here.
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