Regulated Markets Account Management Specialist, PBA Services

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.

• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

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