PBM RFP & Pricing Lead - Remote

Overview

The organization is seeking a highly experienced PBM RFP & Pricing Lead to own and enhance the end-to-end pharmacy RFP process. This is a hands-on, strategic role focused on product ownership of the RFP process, pricing model development, and PBM financial evaluation.

This role reports to and partners closely with the Director of PBM Performance, taking strategic direction while owning execution, process development, and advancement of the RFP function.

Responsibilities

RFP Process Ownership & Optimization

• Own and continuously improve the end-to-end PBM RFP process, from strategy and development through evaluation and finalist selection
• Standardize RFP structures, question sets, and evaluation methodologies across clients
• Identify opportunities to streamline workflows and implement tools/technology to increase efficiency and scalability
• Mentor and lead junior team members and help build and mature the RFP team’s capabilities

PBM Financial Modeling & Underwriting Analysis

• Lead development and refinement of PBM pricing models (discount guarantees, rebate structures, admin fees, specialty pricing, etc.)
• Evaluate and normalize bidder financial proposals to enable true “apples-to-apples” comparisons
• Analyze key drivers of cost (ingredient cost, utilization, rebates, clinical programs) and identify risk/opportunity areas
• Validate underwriting assumptions and challenge PBM pricing methodologies

Bid Evaluation & Strategy

• Translate complex PBM proposals into clear financial and strategic insights for internal teams and clients
• Identify pricing risks, hidden fees, and contractual nuances that impact total cost of care
• Support finalist negotiations with data-driven recommendations and scenario modeling

Product, AI & Capability Development

• Act as a “product owner” for RFP tools, models, and analytics (Excel-based, SQL-driven, or platform-based solutions)
• Assist in the design, development, and implementation of AI-driven capabilities to enhance the RFP process, including:
  • Automated extraction of PBM contract terms and pricing components
  • AI-assisted summarization and comparison of bidder responses
  • Predictive modeling and benchmarking of PBM pricing outcomes
• Partner with analytics and engineering resources to translate RFP workflows into scalable systems and tools
• Continuously identify opportunities to leverage AI and automation to reduce manual effort, improve accuracy, and increase speed

Cross-Functional Collaboration

• Work with audit, analytics, and consulting teams to align RFP outputs with downstream audit and monitoring strategies
• Support business development efforts by contributing to proposals and client presentations
• Serve as a subject matter expert on PBM pricing and market dynamics

Qualifications

• 5–10+ years of experience in PBM consulting, underwriting, pricing, or RFP strategy
• Deep understanding of PBM financial models, including:
  • AWP discounts, MAC pricing, and ingredient cost structures
  • Rebate guarantees (PMPM, per-claim, hybrid models)
  • Specialty pharmacy economics and trend drivers
  • Administrative fees and contract financial terms
• Experience building and/or evaluating PBM RFPs and bidder responses
• Advanced Excel skills required; experience with SQL, data tools (Qlik, Power BI, Tableau), or RFP platforms is a strong plus
• Exposure to AI tools, automation, or data product development (or strong interest in applying AI to business processes)
• Strong analytical and problem-solving skills with high attention to detail
• Ability to translate complex data into clear, executive-level insights
• Self-starter who thrives in a build/scale environment

Preferred Qualifications

• Not specified

Compensation & Benefits

• Typical base pay range (nationwide): $90,000 to $150,000 per year
• Base pay is dependent upon skills, education, qualifications, professional experience, and location
• Some roles may be eligible for variable compensation, commission, and/or annual bonus based on individual performance and/or the organization’s performance
• Benefits may include health and wellbeing benefits, retirement, other financial benefits, paid time off, overtime pay for non-exempt employees, and robust learning and development programs
• Reimbursement of job-related expenses per company policy; employee perks and discounts may be available

Location

• United States (must be eligible to work in the United States without the need for work visa or residency sponsorship)