PBM Pricing & RFP Manager

We are seeking an experienced PBM RFP & Pricing Lead for a major insurance client of ours to manage and enhance the end-to-end pharmacy benefit manager (PBM) RFP process. This hands-on role focuses on RFP strategy, financial modeling, underwriting analysis, and AI-driven process improvement.

Reporting to the Director of PBM Performance, you will translate strategic priorities into scalable processes, strengthen pricing capabilities, and mentor junior team members while helping modernize the RFP function.

Key Responsibilities

• RFP Ownership: Lead the full RFP lifecycle, standardize evaluation frameworks, optimize workflows, and develop team capabilities.
• Financial Modeling & Underwriting: Build and refine PBM pricing models, normalize bidder proposals, evaluate cost drivers, validate assumptions, and identify financial risks and savings opportunities.
• Bid Evaluation & Strategy: Translate complex proposals into actionable recommendations, identify hidden fees and contractual risks, and support finalist negotiations through scenario modeling.
• AI & Technology: Own RFP tools, models, and analytics; help develop AI capabilities for contract extraction, proposal comparisons, and pricing benchmarks; partner with analytics and engineering teams to scale automation.
• Cross-Functional Collaboration: Partner with audit, analytics, and consulting teams, support business development proposals and presentations, and serve as a subject matter expert on PBM pricing and market dynamics.

Qualifications

• Background in PBM consulting, pricing, underwriting, or RFP management, with 5–10+ years of relevant experience.
• Advanced Excel proficiency, with experience using SQL, business intelligence tools such as Qlik, Power BI, or Tableau, or dedicated RFP platforms considered an asset.
• Demonstrated ability to analyze complex financial data, solve problems, identify pricing discrepancies, and communicate findings clearly to executive-level audiences.
• Familiarity with AI-enabled tools, workflow automation, or data product development, or a strong desire to apply emerging technologies to improve business processes.
• Practical experience assessing PBM bids and managing or developing RFP processes.
• Comprehensive understanding of PBM economics, including ingredient costs, AWP discounts, MAC pricing, rebate guarantee structures (PMPM, per-claim, and hybrid), specialty pharmacy cost drivers, administrative fees, and contractual financial terms.
• A proactive, independent working style, with the ability to establish new processes, improve existing capabilities, and contribute in a growing environment.

What Success Looks Like

• A standardized, scalable RFP process with less reliance on individual knowledge.
• Accurate, repeatable pricing models that support confident financial comparisons.
• AI-enabled workflows that improve speed, accuracy, and efficiency.
• Clear, defensible recommendations that improve client outcomes and deliver measurable savings.