Principal PBM Operations Analyst

Blue Cross and Blue Shield of Minnesota; Eagan (MN); On-site; USD 102,400 - 138,300; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k)

Paid Time Off (PTO)

Job summary

Blue Cross and Blue Shield of Minnesota is looking for a Principal PBM Operations Analyst to refine operational processes for Medicare products in Eagan, Minnesota. This hybrid position requires candidates with extensive experience in pharmacy and project management.

Responsibilities include overseeing Pharmacy Benefit Managers, developing KPIs, and responding to inquiries related to Medicare benefits. The role demands at least 10 years of relevant experience and offers a competitive salary range of $102,400 - $174,200 annually.

Qualifications

• 10+ years of professional experience in pharmacy at a health plan or PBM.
• 7+ years of project management/relationship management experience.
• 5+ years of experience working with Medicare Part D.

Responsibilities

• Manage operational processes for Pharmacy Benefit Manager(s).
• Develop and manage dashboards for PBM oversight.
• Oversee intake and resolution of inquiries related to benefits.

Skills

Pharmacy experience in health plan or PBM

Project management skills

Claims and benefits resolution

Management experience

Education

High school diploma or equivalent

Bachelor's degree or equivalent experience

Job description

Overview

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 affirmative action plan, as required by Minnesota law for 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.

Position Details

Position Title: Principal PBM Operations Analyst
Location: Hybrid | Eagan, Minnesota
Career Area: Health Services

The Impact You Will Have

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

Responsibilities

• Core responsibilities involve project management, operational management, and oversight of the Pharmacy Benefit Manager(s) (PBM).
• Build and manage dashboards for PBM oversight reporting, including volume trending/analysis and quality review outcomes of key performance indicators such as claims, coverage decisions, appeals, formulary, and networks. Present dashboards/reporting to the Compliance Officer and Leadership as applicable.
• Continuously assess risk and evaluate the oversight program for improvement opportunities. Define and document oversight processes, policies, and procedures for delegated pharmacy functions, including those intended to identify risk and internal controls.
• Develop enhancement strategies for existing processes and technology capabilities. Manage enhancement-related projects with cross-functional teams including IT, Pharmacy, Operations, Compliance, etc.
• Develop and manage project plans for PBM, internal stakeholders, or external vendor initiatives to ensure accurate, timely, and highly coordinated implementation.
• Oversee PBM and Pharmacy Analyst work of Medicare PBM operational components.
• Manage and oversee Medicare Part D requirements and corresponding operational processes, including payment integrity (PDE/Encounter Data, FIR's, NX Transactions, Coordination of Benefits), regulatory implementation of guidance, audit management, regulatory reporting, CMS and DHS interactions, coverage decisions and appeals, claims, benefits, formulary/PDL, networks, and materials.
• Establish PBM KPIs and program dashboards to manage and measure outcomes related to performance guarantees.
• Draft and maintain administrative pharmacy policies related to core job responsibilities.
• Collaboratively work with internal and external partners, clients, and vendors.
• Oversee intake, management, and resolution of inquiries, issues, or requests for information received from members, groups, clients, CMS/DHS, and/or any other channel.
• This position does not have direct supervisory responsibilities but will oversee analyst work product.

Required Experience and Skills

• 10+ years of professional experience in pharmacy at a health plan or PBM.
• 7+ years of project management/relationship management experience, preferably in pharmacy or healthcare industry.
• 5+ years of experience in triaging and resolving inquiries related to claims and benefits.
• 7+ years of experience working Medicare Part D.
• 5+ years of management experience (employees and/or vendor services).
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Experience and Skills

• Previous experience in a pharmacy technician role, with or without certification.
• PBM experience preferred.
• Bachelor's degree or equivalent experience.

Compensation and Benefits

Pay Range: $102,400.00 - $138,300.00 - $174,200.00 Annual

Pay is based on several factors that vary by position, including skills, ability, and knowledge the selected individual brings to the role.

We offer a comprehensive benefits package which may include:

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

Please review our benefits page.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. The team meets in the office two days each week – most teams designate at least one anchor day to ensure interaction. The rest of the week you are empowered to work remotely.

Equal Employment Opportunity Statement

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

Equal employment opportunity, including veterans and individuals with disabilities.