Regulated Markets Account Management Specialist, PBA Services

Location: Hybrid (Local to NYC or Denver area)

Position Summary:

The Regulated Markets Specialist serves as the primary regulatory expert within the client services organization, acting as a strategic liaison between Government Program Operations, Compliance, and Regulatory Affairs. This client-facing subject matter expert ensures that Capital Rx's regulatory interpretations are consistently and proactively communicated to clients and internal teams. By closely monitoring evolving regulatory frameworks, the Specialist assesses their impact on client programs, develops best practices in partnership with cross-functional experts, and embeds compliance requirements into service delivery. They take full ownership of regulatory communications, advising account teams and clients to ensure transparency, accuracy, and adherence to applicable rules. In this role, the Specialist also anticipates state-specific compliance risks and provides clear, actionable guidance to support client strategies, mitigate regulatory risk, and drive operational excellence.

Position Responsibilities:

• Partner closely with and serve as a liaison between the Government Program (GP) Operations and Regulatory business areas to support Account Management teams in addressing clients' regulatory inquiries and requests.
• Work with internal SMEs to bring forward updates in regulations, internal processes, and industry trends shared by functional areas to support Account Management teams with delivering proactive information to clients.
• Prepare for and support internal and external audits related to CMS, Medicaid, and state-specific requirements.
• Support the coordination of Medicare Part D pre-delegation and delegation audits.
• Support the implementation of state mandates in coordination with Account Management teams and Regulatory business areas.
• Manage and monitor internal tracking systems (i.e., Salesforce, JIRA) related to Compliance, Regulatory and/or GP Operations support.
• Assist Account Management teams in identifying regulatory changes shared by regulated functional areas via internal resources (i.e., PBM Source, Regulatory logs, Slack channels and GP Ops internal meetings).
• Partner with account management teams to provide strategic guidance to clients in regulated industries.
• Review and validate project deliverables for regulatory compliance before client submission.
• Support pre-sales and business development with input on regulatory feasibility and risk (i.e., TDA Prior Authorization components).
• Collaborate with Legal and Compliance teams on Root Cause Analyses (RCAs) and Corrective Action Plans (CAPs).
• Support Operations and Implementation teams with day-to-day client requirements as delegated.
• Support Account Management teams by executing timely and accurate benefit change form requests.
• Analyze incoming client requests and work with internal and external teams to complete required plan documentation.
• Monitor oversight tracker to ensure accurate completion of reviews by CAMs and Account managers for Part D compliance validation.
• Research and respond to claims processing and system configuration inquiries.
• Collaborate cross functionally to support general client operations, as required.

Required Qualifications:

• Undergraduate bachelor's degree
• 3 - 5 + years of proven experience in PBM / health plan, benefits consulting, healthcare
• Track record of building trusting internal and external relationships
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Experience in working with regulated lines of business
• Experience working with structured and unstructured data
• Proficient in Microsoft Office,
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• An ability to work well independently and be an effective collaborator within and across teams

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Base salary: $125,000 - $135,000

About Capital Rx

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi, the company's cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.