Pharmacy Operations Analyst - #257959

Summary

We are currently hiring for a Pharmacy Operations Analyst to join BlueCross BlueShield of South Carolina. In this role as a Pharmacy Operations Analyst, you will provide key operations support and guidance on the Pharmacy Benefit Management (PBM) Support Team. Serves as an operations liaison to ensure high levels of service are delivered. As a subject matter expert in the Pharmacy Benefit Management (PBM) benefit administration, this position will drive identification and resolution of issues by partnering with our internal and external customers and our PBM.

Description

Location:

This position is full-time (40 hours/week) Monday-Friday from 8:00 am – 5:00 pm ET and can be hybrid or fully remote depending on the candidate’s residing location.

What You’ll Do

• Assist PBM Operations Manager with primary objectives to lead PBM related services including partnership with Pharmacy Support, Management, and Marketing representatives. Provides strategic planning and account management for accounts.
• Support escalations as required within various teams, assisting to hold PBM vendor accountable. Ensure holistic solutions are developed. Makes recommendations for improvements to meet customers' expectations.
• Partner with PBM’s Operations areas to drive resolution of issues and process gaps including root cause analysis, mitigation and issue prevention. Streamline operational processes and support development, management and compliance of standard operating procedures. Interfaces with operations to ensure smooth delivery of services.
• Partner with PBM on IT development efforts to streamline operational efficiencies. Participates in efforts to support standardization across accounts and works in multi-disciplinary teams to design and implement product and operational enhancements.
• Manages the new and renewal implementation process for accounts. Maintains ongoing account relationships at multiple levels throughout the organization. Provides both on-site and off-site customer service, which may include interpreting plan design, researching and resolving phone and written inquiries, resolving claims, benefit and enrollment issues. Coordinates open enrollment meetings, renewal processes, and training sessions. Develops implementation processes and manages reporting processes to ensure client retention and high levels of account satisfaction.
  
  

To Qualify For This Position, You'll Need The Following

• Required Education: Bachelor's
• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
• Work Experience: 5 years Health Plan, Pharmacy or PBM Experience. 5 years of Account Management Experience (may be concurrent).
• Skills and abilities: Strong oral and written communication skills. Strong negotiations skills. Ability to prioritize work and meet deadlines. Ability to work in a self-motivated environment with limited supervision. Understanding of Fully Insured and ASO benefit set-up, including integrated near real time transactional processes. Previously demonstrated interaction with or understanding of IT systems, processes and testing protocols.
• Software and other tools: Microsoft Office
  
  

We Prefer That You Have The Following

• 5 years of pharmacy benefit management operations or account management experience working at a PBM or health plan.
• Previous demonstrated experience working with large health plan.
• Previous Medicaid experience and understanding of their policies and procedures.
• Familiarity with RX claims and Pharmacy Benefit claims.
• Previous operation program management experience
• Previous issue management experience.
  
  

Our Comprehensive Benefits Package Includes The Following

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more
  
  

What We Can Do For You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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