Manager, Quality Assurance & Benefits Configuration

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. The Quality Assurance (QA) Manager, Benefits Configuration will build, launch, and lead our QA program for benefits configuration within our Pharmacy Benefit Manager (PBM) organization. This is a highly visible, hands on leadership role responsible for establishing QA strategy, designing scalable processes, and ensuring the accuracy and integrity of benefit configurations that directly impact our clients, members, and downstream operational teams. Role And Responsibilities Program Development & Leadership Design, launch, and continuously refine a comprehensive QA program for benefits configuration, including frameworks, workflows, documentation standards, and quality metrics. Establish QA methodologies, including test plans, test cases, regression testing, and validation protocols tailored to PBM benefit structures. Partner with cross‑functional teams—Configuration, Clinical, Operations, Client Services, and IT—to ensure alignment on quality standards and implementation timelines. Develop and maintain QA policies, SOPs, and best practices to support consistent, repeatable, and auditable processes. Serve as the primary point of contact for QA inquiries related to benefit configuration. Hands‑On Quality Assurance Execution Perform detailed QA reviews of benefit configurations, including formulary rules, accumulators, utilization management criteria, pricing logic, and network parameters. Validate configuration accuracy against client requirements, benefit designs, regulatory guidelines, and internal standards. Conduct root‑cause analysis for defects and partner with configuration teams to drive timely resolution. Build and maintain test data, scenarios, and tools to support ongoing QA activities. Monitor and track defect trends, identifying opportunities for process improvement and automation. Team Leadership & Collaboration Act as a working manager—balancing leadership responsibilities with hands‑on QA work. Hire, mentor, and develop a high‑performing QA team as the program scales. Foster a culture of accountability, continuous improvement, and operational excellence. Provide training and guidance to internal teams on QA processes, benefit interpretation, and configuration quality expectations. Quality Metrics & Reporting Define and track KPIs related to configuration accuracy, defect rates, and audit outcomes. Deliver clear, actionable reporting to leadership and stakeholders. Recommend and implement improvements based on data insights and industry best practices Qualifications And Education Requirements 5+ years of experience in PBM, health plan, or healthcare benefits administration, with at least 2 years in QA, configuration, or related functions. Strong understanding of pharmacy benefit design, formulary structures, accumulators, UM/PA logic, and claims processing. Proven experience building or enhancing QA programs, frameworks, or processes. Exceptional attention to detail and analytical skills. Ability to interpret complex benefit requirements and translate them into testable scenarios. Experience working cross‑functionally in a fast‑paced, deadline‑driven environment. Strong communication skills with the ability to influence and collaborate at all levels. Familiarity with PBM configuration platforms, claims systems, or adjudication engines. Demonstrated ability to lead high performing teams through change and drive operational excellence. Preferences Experience with SQL, test automation tools, or data validation techniques. Knowledge of regulatory requirements (CMS, ERISA, state mandates) impacting pharmacy benefits. Physical Requirements The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation. What We Do LucyRx is an independent, next-generation pharmacy benefits manager (PBM) transforming how healthcare works. We’re fixing what’s broken in the PBM industry by putting people first and challenging outdated norms. For too long, traditional PBMs have prioritized profit over patients, and we believe that’s just plain wrong. LucyRx offers bold, innovative solutions powered by LucyIQ, our proprietary AI platform, to deliver actionable insights that lower costs, improve care, and simplify prescription management. While we’re new to the PBM space, LucyRx is built on decades of leadership experience and a commitment to meaningful change. We’re a nimble, remote-first team with a bold mission to redefine pharmacy benefits—and we’re just getting started. What It’s Like to Work at LucyRx At LucyRx, we’re a fast-moving team dedicated to making healthcare simpler, fairer, and more effective. Joining us means being part of a dynamic, mission-driven group that works collaboratively to challenge outdated industry practices and redefine what’s possible in pharmacy benefits. We value accountability, innovation, and a relentless focus on making an impact. Here, you’ll find a supportive culture that encourages you to bring your whole self to work, share bold ideas, and grow alongside smart, driven colleagues who are passionate about fixing the PBM industry. If you’re ready to roll up your sleeves and make a real difference, we’d love to have you on our team. Salary: $115,000 - $131,000 annually