Pharmacy Services Specialist

bcbsnc; United States; On-site; USD 46,000 - 73,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Health and wellness programs

Parental leave and surrogacy support

Tuition reimbursement

401k with company match

Career development programs

Job summary

Blue Cross NC is seeking a Pharmacy Services Specialist to help develop and manage pharmacy benefit programs for current and new plan designs. You will coordinate daily PBM operations, support staff, and collaborate with stakeholders to implement initiatives.

The ideal candidate brings strong communication, solid time management, and proficiency with Microsoft Office Suite, with willingness to work weekends/holidays to meet business needs.

Qualifications

• High School Diploma or GED.
• 3+ years of experience in related fields.

Responsibilities

• Coordinate daily PBM operations and benefits administration.
• Support staff and coordinate tasks for program development and evaluation.
• Advise on pharmacy needs and project inputs across initiatives.
• Resolve issues or escalate to management as needed.
• Coordinate review and QA of benefit plan administration with stakeholders.
• Address escalated customer service inquiries and adjust pharmacy claims.
• Coordinate pharmacy coverage determinations with clinical staff and partners.
• Coordinate claim reconsiderations and appeals with Appeals and partners.
• Assist responding to RFPs and government program applications.

Skills

Strong communication

Interpersonal skills

Time management

Microsoft Office

Weekend/holiday coverage

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
• 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