Benefit Configuration Specialist

Position Summary We are seeking a Benefits Configuration Specialist (PBM) to join our team. This role is responsible for configuring and maintaining pharmacy benefit plans, business rules, rates, and provider networks within the claims adjudication system. The ideal candidate will ensure configuration accuracy through testing and quality assurance while supporting client implementations, system demonstrations, and cross-functional initiatives. Key Responsibilities Configure and maintain pharmacy benefit plans, business rules, rates, and networks in the claims adjudication system. Validate system configurations by entering and testing claims. Perform quality assurance reviews to ensure configuration accuracy. Support User Acceptance Testing (UAT) by developing and executing test scenarios and documenting results. Research and resolve benefit configuration and claims processing inquiries. Provide configuration support and consultation to internal teams and clients. Prepare and deliver system demonstrations, client presentations, and training sessions as needed. Collaborate with Implementation, Account Management, Sales, and Quality teams to ensure successful client implementations. Analyze client requests and recommend the best configuration solutions using existing system capabilities. Identify process improvements and recommend system enhancements when appropriate.

Equal Opportunity Employer / Disabled / Protected Veterans

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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

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We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Additional Skills

TRAINING & EDUCATION Pharmacy Technician Associate Degree or equivalent professional experience. LICENSURE / CERTIFICATION Puerto Rico Board of Pharmacy Technician Certification (Preferred).  PROFESSIONAL EXPERIENCE One (1) year experience in a PBM/Health Plan Environment (Preferred) or Proven working experience as a data analyst. PROFESSIONAL COMPETENCIES Knowledge: Experience in health insurance industry or PBM is desired.  Knowledge of federal and The Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies is preferred.