Director, System Configuration and Process Improvement

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 Director, System Configuration and Process Improvement, will serve as a senior leader within our operations team, responsible for two critical and interconnected functions: the accurate, scalable configuration of pharmacy network and client pricing systems, and the design and execution of Process Improvement initiatives. This is a highly visible, hands-on leadership role that requires deep PBM operational expertise and the ability to drive measurable outcomes across both system integrity and operational excellence. The Director will oversee the full lifecycle of system configuration—from contract interpretation through deployment and quality assurance—while simultaneously establishing and advancing a formal Process Improvement program that impacts clients, members, and internal teams alike.

                                                                                                                                                                                                                                                                   

Role and Responsibilities

System Configuration Leadership & Execution

• Lead and oversee the configuration and maintenance of client billing and pharmacy network reimbursement terms (MAC, U&C, brand/generic rates, specialty pricing, etc.) within PBM claims processing systems.
• Interpret complex contract language and translate it into precise system rules, rate tables, and network attributes.
• Direct the development and implementation of pricing structures for retail, mail, and specialty networks, including pricing libraries, rate matrices, and configuration standards.
• Validate network and client configurations through test claims and scenario modeling to ensure accuracy prior to deployment.
• Perform root cause analyses on pricing or reimbursement issues identified through audits, escalations, or client inquiries, and drive timely and sustainable resolution.
• Ensure all system configurations comply with internal controls, regulatory requirements, and contractual obligations.
• Maintain thorough documentation of configuration decisions, methodologies, and testing results to support consistency and auditability.
• Partner with Network Contracting, Client Services, Operations, and IT to ensure full alignment on pricing and network requirements across client implementations, renewals, and custom requests.

Process Improvement Program Development & Leadership

• Design, launch, and continuously refine a comprehensive Process Improvement program, including frameworks, workflows, documentation standards, and performance metrics.
• Establish PI methodologies—including process mapping, gap analyses, root cause analyses, and improvement protocols—tailored to PBM operations and benefit administration.
• Partner with cross-functional teams—Configuration, Clinical, Operations, Client Services, and IT—to ensure alignment on performance standards, improvement initiatives, and implementation timelines.
• Develop and maintain PI policies, SOPs, and best practices to support consistent, repeatable, and auditable improvement processes.
• Serve as the primary point of contact for Process Improvement inquiries and initiatives across the organization.
• Must have personally designed and implemented a centralized Process Improvement function or framework across multiple business units.

Hands-On Process Improvement Execution

• Conduct detailed operational reviews across key PBM functions, including claims processing, benefit configuration, formulary management, utilization management, and member/client services.
• Identify performance gaps and inefficiencies through data analysis, audits, and stakeholder feedback, and develop targeted improvement plans.
• Lead root cause analyses for operational failures, errors, or client escalations and partner with cross-functional teams to drive sustainable resolution.
• Build and maintain performance benchmarks, scorecards, and tracking tools to support ongoing improvement activities.
• Monitor trend data to proactively surface opportunities for process optimization and automation.

Quality Assurance & Compliance

• Participate in audits, remediation activities, and continuous improvement initiatives related to system configuration and operational performance.
• Ensure all processes and configurations adhere to internal controls, compliance standards, and industry best practices.

Performance Metrics & Reporting

• Define and track KPIs related to configuration accuracy, operational efficiency, error rates, turnaround times, and client satisfaction.
• Deliver clear, actionable reporting to leadership and key stakeholders on process trends, configuration outcomes, and improvement results.
• Recommend and implement enhancements based on data insights, client feedback, and industry best practices.

                                                                                                                                                                                                                                                                   

Qualifications and Education Requirements

• 5+ years of experience in PBM, health plan, or healthcare benefits administration, with at least 3 years in a leadership role spanning operations, system configuration, process improvement, or operational excellence.

• Deep understanding of pharmacy benefit operations, including claims adjudication, formulary structures, utilization management, benefit configuration, pharmacy network setup, and member/client services.

• Hands-on experience with pharmacy network and client pricing configuration within PBM claims processing systems, including MAC, U&C, AWP, WAC, dispensing fees, and specialty pricing models.

• Proven experience building or enhancing Process Improvement programs, frameworks, or processes from the ground up.

• Expertise in process improvement methodologies (Lean, Six Sigma, or equivalent); certification preferred.

• Proficiency with data tools such as Excel, SQL, or BI platforms; ability to translate complex data into clear insights and actionable recommendations.

• Ability to interpret complex contract terms and convert them into precise system logic and configuration rules.

• Experience working cross-functionally in a fast-paced, deadline-driven environment with strong communication and influencing skills.

• Familiarity with PBM platforms, claims systems, or adjudication engines.

• Demonstrated ability to lead high-performing teams through change and drive sustainable operational results.

• High attention to detail and commitment to accuracy in both configuration and process improvement work.

Preferences

• Bachelor degree in Business, Finance, Data Analytics, Healthcare Administration, or a related field

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:
$152,900-$167,400 annually