Associate Counsel – Pharmacy Benefit Management
Blue Cross and Blue Shield of North Carolina
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Benefits offered by this job
Job summary
Blue Cross NC seeks an Associate Counsel to support PBM services and related health plan operations, including government programs. You will advise on PBM contracts, regulatory compliance, data privacy, and vendor oversight, partnering with cross-functional teams to reduce risk and ensure legal soundness.
The role involves collaboration with pharmacy, compliance, operations, and executive teams, handling audits, public records requests, and complex service agreements to support enterprise PBM
Qualifications
- Graduate of an accredited law school required.
- 3+ years of experience in related field.
- Licensed to practice law.
- Experience supporting PBM, health plan administration, or government programs is a plus.
- Experience advising on PBM contracts, pharmacy benefits, rebates, formulary matters, or vendor oversight.
Responsibilities
- Develop and maintain a strong working knowledge of PBM contracts and legal requirements, including vendor obligations, performance guarantees, reporting, milestones, financial terms, audit rights, data obligations, and operational commitments.
- Review PBM-related materials and provide practical, legally supportable guidance to business partners.
- Advise internal partners on PBM contractual requirements including pharmacy benefits, claims processing, rebates, pricing, reporting, 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 on federal and state requirements impacting pharmacy benefits and health plan administration, including privacy, data use, transparency, and claims administration.
- Support implementation and ongoing administration of pharmacy benefit initiatives, vendor integrations, reporting processes, and workflows.
- Advise on privacy, security, data governance, confidentiality, and information-sharing requirements.
- Support responses to audits, regulatory requests, and contract compliance reviews.
- Assist with public records requests and protection of sensitive information.
- Monitor legal developments affecting PBM, government programs, and State Health Plan operations.
- Provide support on member complaints, appeals, grievances, claims, and vendor disputes.
- Develop and deliver training to business partners on legal, regulatory, and compliance topics.
Skills
Education
Job description
We’re seeking an Associate Counsel to join our legal team as legal support for Blue Cross NC’s Pharmacy Benefit Manager (PBM) services, including services provided to the North Carolina State Health Plan for Teachers and State Employees. This role is well-suited for an attorney interested in working at the intersection of health care, pharmacy benefit administration, government programs, public procurement, and highly regulated health plan operations. This position requires a strong command of state and federal laws and regulations impacting pharmacy benefit administration and health plan operations. This role will partner closely with pharmacy, compliance, operations, data, finance, vendor management, and executive teams to help ensure contractual compliance, manage legal risk, and provide timely, legally supportable guidance across Blue Cross NC’s PBM operations and client relationships. The role will support matters involving the North Carolina State Health Plan as well as other PBM and pharmacy initiatives across the enterprise.
- 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.
- Graduate of an accredited law school required.
- 3+ years of experience in related field.
- Licensed to practice law.
- Bonus Points Experience supporting pharmacy benefit management, pharmacy benefits, health plan administration, self-funded health plans, government-sponsored health programs, or large employer group health plans.
- Experience advising on PBM contracts, pharmacy benefit administration, rebate arrangements, formulary matters, pharmacy networks, specialty pharmacy, claims administration, or vendor oversight.
- Familiarity with Chapter 135 of the North Carolina General Statutes, the North Carolina State Health Plan, public procurement, government contracting, and public records laws.
- Experience assessing the applicability of insurance regulatory requirements to governmental or self-funded health plan arrangements.
- Experience advising on federal requirements impacting health plans, pharmacy benefits, privacy, data use, transparency, claims administration, or vendor management.
- Experience reviewing and interpreting complex service agreements, performance guarantees, implementation requirements, reporting obligations, financial terms, and audit provisions.
- Strong issue-spotting ability and demonstrated judgment in identifying, escalating, and helping resolve legal, regulatory, contractual, and operational risks.
- Ability to provide timely, practical, legally supportable feedback in a fast-moving client-service environment.
- Ability to translate complex legal and contractual requirements into clear, actionable guidance for business partners and Plan stakeholders.
- Excellent written and oral communication skills, including experience supporting senior leadership, operational teams, external stakeholders, and counsel.
- Collaborative approach to client service, vendor oversight, and relationship management.
- Intellectual curiosity, adaptability, sound judgment, and a strong learning mindset.
- The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community.
- Work-life balance, flexibility, and the autonomy to do great work.
- Medical, dental, and vision coverage along with numerous health and wellness programs.
- Parental leave and support plus adoption and surrogacy assistance.
- Career development programs and tuition reimbursement for continued education.
- 401k match including an annual company contribution.
- Learn more.
Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in‑person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid‑Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote‑Flex role, you’ll work virtually, with a few in‑office visits each year for meaningful moments that matter. Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market‑price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $130,560.00 - $208,896.00
- Business Contracts
- Contract Evaluations
- Contract Management
- Contract Negotiations
- Contract Operations
- Contracts Analysis
- Government Affairs
- Law
- Legal Agreements
- Legal Compliance
- Legal Documents Preparation
- Legal Practices
- Legal Representation
- Legal Services
- Outside Counsel Management
- Regulations
- Regulatory Compliance
- Regulatory Filings
- Statutory Interpretation
It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (BlueCrossNC). Health care is changing, and we’re leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well‑being of North Carolinians. BlueCrossNC is a fully taxed, not‑for‑profit company headquartered in Durham, NorthCarolina. We serve more than 4.3million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.
We use E‑verify to confirm authorization to work in the United States. To learn more about E‑Verify, including your rights and responsibilities, please visit E‑Verify Overview for English or Visión General de E‑Verify for Español.
BlueCrossNC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at HR.Staffing@bcbsnc.com.
BlueCrossNC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
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