Associate Counsel, PBM & Health Plan Compliance

Blue Cross and Blue Shield of North Carolina

Arkansas

Hybrid

USD 131,000 - 209,000

Full time

14 days+

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Job summary

Blue Cross and Blue Shield of North Carolina seeks an Associate Counsel to support PBM services and regulatory compliance across state and federal health programs. The role partners with legal, compliance, operations, data, and finance teams to ensure contractual compliance and legally sound guidance for PBM contracts and State Health Plan operations.

The ideal candidate has a JD, 3+ years of related experience, and a strong grasp of health plan administration, privacy, and procurement laws.

Qualifications

Graduate of an accredited law school required.
Licensed to practice law.
3+ years of experience in related field.

Responsibilities

Develop and maintain a strong working knowledge of PBM contracts and related legal requirements, including vendor obligations, performance guarantees, reporting requirements, implementation milestones, financial terms, audit rights, data obligations, and operational commitments.
Review PBM-related materials, communications, program documents, policy updates, vendor submissions, and other work product and provide practical, legally supportable guidance to business partners.
Advise internal business partners on the interpretation and application PBM contractual requirements, including requirements related to pharmacy benefit administration, claims processing, formulary support, rebates, pricing, reporting, member communications, audits, and vendor performance.
Serve as legal counsel supporting Blue Cross NC's PBM business, including administration of the State Health Plan PBM contract.
Advise business partners on federal and state legal and regulatory requirements impacting pharmacy benefits and health plan administration, including privacy, data use, transparency, claims administration, and other applicable compliance obligations.
Support implementation and ongoing administration of pharmacy benefit initiatives, benefit changes, vendor integrations, member communications, reporting processes, and operational workflows, including those relating to the North Carolina State Health Plan.
Advise on privacy, security, data governance, confidentiality, and information-sharing requirements applicable to PBM services and Plan operations.
Support responses to audits, investigations, administrative inquiries, regulatory requests, contractual compliance reviews, and other information requests involving PBM services and related operations.
Assist with public records requests, confidentiality analyses, and protection of trade secret, proprietary, confidential, and competitively sensitive information.
Monitor legal, regulatory, legislative, and market developments affecting pharmacy benefit management, government health programs, and State Health Plan operations and communicate practical implications to internal stakeholders.
Provide legal support related to member complaints, appeals, grievances, claims administration issues, pharmacy network issues, benefit interpretation, and vendor disputes.
Develop and deliver training to business partners on legal, regulatory, contractual, and compliance topics relevant to the PBM contract.
Provide support on developing legal issues and perform other duties as assigned.