Benefit Team Lead

Job DescriptionJob DescriptionPOSITION SUMMARYThe Benefits Team Lead position provides hands‑on leadership, subject matter expertise, and operational oversight while partnering closely with cross‑functional teams to support quality, system integrity, and continuous improvement. The ideal candidate thrives in a fast‑paced environment, demonstrates strong judgment, and leads by example through collaboration, accountability, and service excellence.

ESSENTIALS ROLES AND RESPONSIBILITIESFoster a positive, collaborative, and service‑driven team culture through active listening, approachability, respectful communication, and consistent leadership behaviors.Provide day‑to‑day guidance, coaching, and knowledge sharing to Benefits team members to support accuracy, engagement, and professional growth.Serve as the first‑line point of contact for Benefits team inquiries, offering clear, empathetic, and solution‑oriented guidance.Model professionalism, patience, and a customer‑centric mindset in all interactions.Oversee daily benefits operations, ensuring compliance with regulatory requirements, internal controls, organizational policies, and PharmPix guidelines.Coordinate and prioritize daily workload assignments to ensure accuracy, efficiency, and adherence to established Benefit Resolution Time targets.Review and validate client benefit configurations to ensure alignment with business rules and client intent.Identify discrepancies, inaccuracies, or unintended outcomes and take corrective or preventive action as appropriate.Serve as a Subject Matter Expert (SME) on OneArk system functionality, supporting operational teams with configuration guidance and issue resolution.Oversee updates and ongoing maintenance of benefit validation tools and macros.Act as the primary point of contact for Quality Internal Audits (QIA) and Validation requests; oversee, resolve, and document assigned tickets.Provide guidance to team members on QIA and Validation findings to promote quality, consistency, and compliance.Research and respond to claims processing, accumulation, and system configuration inquiries from internal partners.Support User Acceptance Testing (UAT) from a Benefits perspective by developing and executing test plans, scenarios, scripts, and procedures based on change requirements.Identify, document, and escalate defects, configuration issues, and design gaps during testing activities.Partner with testers, system analysts, developers, and business stakeholders to support system readiness and successful implementation.Collaborate closely with Benefits, Quality, IT, Operations, and other internal teams to resolve complex benefits and operational inquiries.Review and analyze client system requests and work to accommodate needs within existing functionality prior to recommending enhancements.Proactively identify process gaps, risks, and operational inefficiencies; perform root cause analysis and present recommendations to leadership.Lead or support process improvement initiatives that enhance efficiency, accuracy, scalability, and employee experience.Support Quality Management Program initiatives by promoting accuracy, compliance, and continuous improvement.Respond promptly and professionally to requests, consultations, and escalations.Meet deadlines in fast‑paced, high‑pressure environments and proactively communicate risks, concerns, or delays.Support internal and external presentations and training sessions by developing clear, professional, and visually effective materials.Perform other related duties as assigned.

TRAINING & EDUCATION Pharmacy Technician Associate Degree or equivalent professional experience (Preferred).

LICENSURE / CERTIFICATIONPuerto Rico Board of Pharmacy Technician Certification (Preferred).

PROFESSIONAL EXPERIENCEOne (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy 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. Skills:Strong working knowledge of benefit plan setup, validation, and claims processing concepts.

Proficiency with benefits administration systems (OneArk experience preferred). High attention to detail with strong analytical and problem‑solving skills. Excellent written and verbal communication skills, with the ability to explain complex concepts clearly.

Proven ability to collaborate effectively across departments and with diverse stakeholders. Strong customer service orientation with sound judgment and professionalism. Ability to manage competing priorities and perform effectively in a fast‑paced environment.Proficient in Microsoft Office.

Abilities:Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals.Ability to read and interpret documents, write reports and correspondence. Ability to organize and integrate organizational priorities and deadlines.Ability to work independently or part of a team.Fully bilingual English and Spanish (Required).Ability to support clients with technical difficulties in a timely manner.Strong problem analysis and decision-making skills.PHYSICAL AND MENTAL DEMANDSThe physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. While performing the duties of this job, the employee is regularly required to talk or hear, sit, stand, and walk.The position may require lifting and moving equipment up to 25 pounds.Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.ENVIRONMENTAL AND WORKING CONDITIONSThis job operates in a professional office environment.

This role routinely uses standard office equipment such as computers, phones, and printers. The position may require evening or weekend work to support maintenance windows, system updates, and incident response.PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans