Pharmacy Services Specialist

Blue Cross and Blue Shield of North Carolina; North Carolina; Hybrid; USD 46,000 - 73,000; Full time

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Pharmacy Services Specialist to help develop and manage pharmacy benefit administration for current and new plan designs. You will coordinate daily operations for PBM and nonclinical review, serving as a subject matter expert on ongoing initiatives.

The role requires a High School Diploma or GED and 3+ years of related experience, with strong communication and organizational skills.

Qualifications

• High School Diploma or GED required.
• 3+ years of experience in related fields.
• Bonus points for strong communication and interpersonal skills.
• Excellent time management and organizational abilities.
• Proficiency with Microsoft Office Suite.
• Must be able to work weekends and holidays as needed to support business and operational requirements.

Responsibilities

• Coordinate daily activities related to operations of pharmacy benefit management.
• Support staff and coordinate tasks for programs, projects and initiatives.
• Serve as resource to staff and subject matter experts for initiatives related to pharmacy needs and projects.
• Resolve issues or escalate to management as appropriate; assist with clinical and contractual issues.
• Coordinate review, implementation, and QA of benefit plan administration with internal stakeholders and PBM team.
• Resolve or coordinate resolution of escalated customer service inquiries and grievances with PBM and internal teams.
• Coordinate resolution of Pharmacy Coverage Determinations with Clinical Staff and external partners as appropriate.
• Coordinate resolution of claim reconsiderations and appeals with Appeals and external partners as appropriate.
• Assist in responding to and coordinating review and approval of RFPs, government program applications, and similar requests.

Skills

Strong communication

Interpersonal skills

Time management

Organizational abilities

Microsoft Office Suite

Education

High School Diploma or GED

Job description

Job Description Summary

We’re hiring a Pharmacy Services Specialist to assist in the development and management of pharmacy benefit administration for current and new plan designs or products. Provides daily coordination of activities related to operations of pharmacy benefit management or nonclinical review and call center support. Serves as subject matter expert for current processes and new initiatives.

What You’ll Do

• Provides daily coordination of activities related to operations of pharmacy benefit management.
• Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives.
• Serves as resource to staff and subject matter experts assigned initiatives to provide input regarding pharmacy needs, impacts and projects.
• Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues.
• Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
• Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate.
• Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate.
• Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
• Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.

What You Bring

• High School Diploma or GED
• 3+ years of experience in related fields
• Bonus Points (preferred qualifications) Strong communication and interpersonal skills.
• Excellent time management and organizational abilities.
• Proficiency with Microsoft Office Suite
• Must be able to work weekends and holidays as needed to support business and operational requirements.

What You’ll Get

• 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

Salary Range

Learn more Salary Range 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. $45,761.00 - $73,217.00

About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). 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. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Location and Working Arrangement

Blue Cross NC 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