Pharmacy Benefit Manager Operations Analyst

Blue Cross & Blue Shield of Minnesota; Eagan (MN); Hybrid; USD 69,000 - 114,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

PTO

Volunteer PTO

Job summary

Blue Cross & Blue Shield of Minnesota is seeking a PBM Operations Analyst to establish and refine processes for CMS/state Medicare requirements. You will create an oversight structure with KPIs and dashboards to measure performance, aligning with vendor and internal partners.

In this hybrid role, you will manage member inquiries and drive policy development. You should have 3+ years in health services, a bachelor's degree or equivalent experience, and strong collaboration skills to navigate

Qualifications

• 3+ years of related health services professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience may be accepted.

Responsibilities

• Establish and refine operational processes for CMS and State requirements for Medicare products.
• Develop an oversight structure of PBM activities with KPIs and program dashboards.
• Oversee Medicare Part D requirements including member escalation management, claims analysis, and reporting.
• Draft and maintain policies related to core job responsibilities.
• Collaborate with internal and external partners, manage inquiries from members, groups, Clients, CMS/DHS.

Skills

Health services experience

Communication

Analytical thinking

Project management

Collaboration

Problem solving

Education

Bachelor's degree

Job description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

As a PBM Operations Analyst, you will focus on establishing and refining operational processes related to CMS and State requirements for Medicare products. In this position, you will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM) departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance.

What You’ll Do

• Core responsibilities will involve operational management and oversight of certain aspects of the Pharmacy Benefit Manager(s) (PBM) and other vendor(s).
• Manage, and oversee Medicare Part D requirements and corresponding operational processes. Including, but not limited to member escalation management, pharmacy claims analysis, and reporting.
• Draft and maintain policies related to core job responsibilities.

How You’ll Do It

• Collaboratively work with internal and external partners, clients, and vendors.
• Intake, manage, and resolve inquiries, issues, or requests for information received from members, groups, Clients, CMS/DHS and/or any other channel.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 3+ years of related health services professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Ability to tailor communication to varied audiences, actively listen to uncover requirements, and ensure accurate and timely information exchange.
• Ability to analyze information, identify patterns and root causes, and collaborate with partners to implement practical solutions.
• Ability to leverage technology to tailor communications to varied audiences, listen to uncover needs, analyze root causes, and collaborate on practical solutions.
• Demonstrated curiosity and willingness to leverage emerging technologies, including artificial intelligence (AI) and automation tools, to improve operational efficiency, data analysis, reporting, and decision-making.
• Ability to effectively organize work, balance competing priorities, and manage time across multiple responsibilities and deadlines.
• Experience and knowledge of pharmacy operations, including PBM, health plan, retail, specialty, or medical pharmacy.
• Experience in triaging and resolving inquiries associated to claims and benefits.
• Experience working with Medicare.
• Experience working with members/clients/patients on the phone.
• Demonstrated project management and strategy development skill set.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits:

Pay Range: $68,900.00 - $91,300.00 - $113,700.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affi cheative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail].

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensee of the Blue Cross and Blue Shield Association.

Physical Requirements