PBM RFP & Pricing Lead - Remote

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 & 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 by providing 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 closely 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

Requirements

• 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

Additional Information

Are you looking to accelerate your career without having to hide your authentic self - a place where you can be you? A career that's making a bigger impact on the world? At OneDigital, we are on a mission to help people do their best work and live their best lives. From the services we offer to the way we show up for each other each day, we are fueling dreams, achieving big goals, and embracing each other's truest selves. We understand that pursuing a new job is a big deal. Maybe you're afraid you won't fit in. Well, here's the good news. For us, the days of "fit in to get in" are over and being different is not a barrier to getting ahead. Greatness comes in all shapes, sizes, colors, and experience levels. If you are looking for a people-first culture that is wired for growth, driven to serve, and totally committed to having your back, give us a shot. Your best life awaits. Must be eligible to work in the United States without the need for work visa or residency sponsorship. Our Newest Opportunity: Position Overview We are seeking a highly experienced PBM RFP & Pricing Lead to own and enhance our 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. The ideal candidate brings deep expertise in PBM underwriting, pricing mechanics, and bid evaluation, with the ability to translate complex financial proposals into clear, actionable insights. This individual will play a critical role in building scalable processes, improving modeling capabilities, and leveraging AI-driven solutions to modernize and accelerate the RFP lifecycle. This role will also provide mentorship and help support the development and growth of the RFP function.

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