Pharmacy Operations Specialist

HMSA; Honolulu (HI); On-site; USD 55,000 - 85,000; Full time

Job summary

HMSA in Honolulu, Hawaii, is seeking an operations specialist to execute pharmacy operational processes and support the implementation of pharmacy benefit, communication, and operational changes. You will perform tasks accurately within established timelines while maintaining adherence to procedures and service standards.

In this role you will apply knowledge of HMSA's drug benefit, analyze impact, validate accuracy, and assist with documentation, testing, and readiness efforts.

Responsibilities

• Execute pharmacy operational processes and activities within an assigned line of business.
• Support implementation of pharmacy benefit, communication, and operational changes.
• Perform operational tasks accurately and within established timelines.
• Maintain adherence to departmental procedures, controls, and service standards.
• Working knowledge and understanding of HMSA's drug benefit and different lines of business
• Interpreting requirements and impact analyses and benefit testing to validate accuracy and intended results
• Analyzes and assess business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency
• Support benefit configuration validation, testing activities, and implementation readiness efforts.
• Review operational outputs to identify discrepancies, issues, and/or data concerns.
• Assist with documentation and maintenance of operational procedures and process materials.
• Support activities associated with pharmacy benefit administration and operational execution.
• Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review
• Identify operational issues, discrepancies, or process breakdowns during routine activities.
• Identifying and assessing operational issues; determining basis for concern
• Applying judgement to address issues within established scope and determine when escalation or guidance is needed
• Escalate issues requiring analyst, pharmacist, and/or leadership review.
• Assist with gathering information and documentation needed to support issue investigation and resolution.
• Participate in implementation and remediation activities as directed.
• Support operational activities impacting members, pharmacies, and/or internal stakeholders.
• Assist with execution and quality review of pharmacy-related communications.
• Help ensure operational processes support a positive and consistent member experience.
• Monitor assigned activities for potential member impact and escalation concerns appropriately.
• Identify opportunities to streamline operational workflows and improve efficiency.
• Participate in process improvement efforts and operational readiness activities.
• Support cross-training initiatives and maintain knowledge of multiple operational processes.
• Contribute to a collaborative and service-oriented team environment.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

Job description

1. 
   

   Operational Execution

   
   
   
   
   • Execute pharmacy operational processes and activities within an assigned line of business.
   
   
   • Support implementation of pharmacy benefit, communication, and operational changes.
   
   
   • Perform operational tasks accurately and within established timelines.
   
   
   • Maintain adherence to departmental procedures, controls, and service standards.
   
   
   
   


2. 
   

   Benefit Administration Support

   
   
   
   
   • Working knowledge and understanding of HMSA's drug benefit and different lines of business
   
   
   • Interpreting requirements and impact analyses and benefit testing to validate accuracy and intended results
   
   
   • Analyzes and assess business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency
   
   
   • Support benefit configuration validation, testing activities, and implementation readiness efforts.
   
   
   • Review operational outputs to identify discrepancies, issues, and/or data concerns.
   
   
   • Assist with documentation and maintenance of operational procedures and process materials.
   
   
   • Support activities associated with pharmacy benefit administration and operational execution.
   
   
   • Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review
   
   
   
   


3. 
   

   Issue Identification & Resolution Support

   
   
   
   
   • Identify operational issues, discrepancies, or process breakdowns during routine activities.
   
   
   • Identifying and assessing operational issues; determining basis for concern
   
   
   • Applying judgement to address issues within established scope and determine when escalation or guidance is needed
   
   
   • Escalate issues requiring analyst, pharmacist, and/or leadership review.
   
   
   • Assist with gathering information and documentation needed to support issue investigation and resolution.
   
   
   • Participate in implementation and remediation activities as directed.
   
   
   
   


4. 
   

   Member Experience & Communication Support

   
   
   
   
   • Support operational activities impacting members, pharmacies, and/or internal stakeholders.
   
   
   • Assist with execution and quality review of pharmacy-related communications.
   
   
   • Help ensure operational processes support a positive and consistent member experience.
   
   
   • Monitor assigned activities for potential member impact and escalation concerns appropriately.
   
   
   
   


5. 
   

   Continuous Improvement & Team Support

   
   
   
   
   • Identify opportunities to streamline operational workflows and improve efficiency.
   
   
   • Participate in process improvement efforts and operational readiness activities.
   
   
   • Support cross-training initiatives and maintain knowledge of multiple operational processes.
   
   
   • Contribute to a collaborative and service-oriented team environment.
   
   
   
   


6. Performs all other miscellaneous responsibilities and duties as assigned or directed.