Associate Counsel, PBM & Health Plan Compliance

Blue Cross and Blue Shield of North Carolina; Indiana (PA); Hybrid; USD 131,000 - 209,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption support

401k match including an annual company

Job summary

Blue Cross NC is seeking an Associate Counsel to join our legal team, supporting PBM services for the State Health Plan and related government programs. The role encompasses health care, pharmacy benefit administration, and highly regulated health plan operations.

You will partner with pharmacy, compliance, operations, data, finance, vendor management, and leadership to ensure contractual compliance, manage legal risk, and provide timely guidance across PBM operations.

Qualifications

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

Responsibilities

• Develop and maintain 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 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, 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.

Education

Graduate of an accredited law school

Job description

Blue Cross NC is seeking an Associate Counsel to join our legal team, supporting PBM services for the State Health Plan and related government programs. The role encompasses health care, pharmacy benefit administration, and highly regulated health plan operations.

You will partner with pharmacy, compliance, operations, data, finance, vendor management, and leadership to ensure contractual compliance, manage legal risk, and provide timely guidance across PBM operations.