Solutions and Services Architect
Personify Health1 day ago
Remote, United States or Tempe, AZ, USASenior
Base Salary
$85k - $118k/yr
Responsibilities
- Design end-to-end TPA operational workflows across eligibility, claims, billing, and benefit administration.
- Translate cross-functional operational requirements into structured solutions for Claims, Eligibility, Implementation, Account Management, Finance, Compliance, and Tech Ops.
- Own PBM solution design, including current-state system mapping and future-state data flows and file exchanges.
- Define PBM file formats, data exchange standards, and service-level agreements with Pharmacy Strategy.
- Lead PBM performance reviews, escalations, and end-to-end vendor onboarding.
- Partner with PBMs to influence product offerings for current and prospective clients.
- Develop training materials and educate internal teams on PBM and TPA operations.
- Monitor drug cost containment, PMPM performance, vendor costs, pricing structures, and rebate guarantees.
- Negotiate rebate and pricing agreements and identify client savings opportunities.
- Provide leadership visibility into TPA and PBM operational health and represent performance in client reviews.
- Create SOPs and documentation supporting continuous improvement.
Requirements
- 7+ years of experience in healthcare, TPA operations, product, systems architecture, implementation, or related fields.
- Background in PBM operations, data file formats, data dictionaries, and compliance requirements.
- Experience with pharmaceutical rebate structures, formulary management, and drug cost containment strategies.
- Working knowledge of legal and regulatory requirements governing PBM operations and data sharing, including HIPAA and CMS.
- Experience mapping complex processes and building end-to-end workflow designs.
- Knowledge of data management systems and analytics tooling.
- Knowledge of PBM data file formats and data exchange standards.
- Experience with rebate and pricing agreement structures.
- Experience developing process documentation and SOPs.
Benefits
- Competitive base salary and benefits effective day one.
- Comprehensive medical and dental coverage through Personify Health's health solutions.
- Unlimited paid time off.
- Mental health support, retirement planning, and financial protection.
- Professional development, career progression, and learning budgets.
- Mission-driven, inclusive culture focused on health and wellbeing.
Categories
Solutions Engineering
About Personify Health
Personify Health builds a personalized health platform that unifies health plan administration (TPA), wellbeing programs, care navigation, and condition management for employers, health plans, and health systems. It delivers claims processing, payment integrity, and case management through enterprise contracts that bundle SaaS with administrative and clinical services. Founded in 2023 and privately held, the company is headquartered in Fresno, California, and was formed from the merger of Virgin Pulse and HealthComp.