Program Coordinator I-PBM

State of South Carolina; Columbia (SC); On-site; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking government agency dedicated to protecting insurance consumers and ensuring compliance within the insurance marketplace. This role involves processing license applications and overseeing complaints related to pharmacy benefit managers and service providers. You will play a crucial part in maintaining the integrity of the insurance industry while working independently and collaboratively with various stakeholders. With opportunities for professional growth and a supportive work environment, this position is ideal for those looking to make a meaningful impact in public service.

Benefits

Health Insurance

Flexible Schedules

Gym Access

Growth Opportunities

Retirement Plans

Counseling Services

Leave Days

Holidays

Workplace Programs

Qualifications

• 3+ years of experience with PBMs, PSAOs, or related fields.
• Ability to analyze contracts and evaluate responses.

Responsibilities

• Process licensing applications for various entities under PBM Oversight.
• Review and investigate complaints against PBMs and PSAOs.

Skills

Compliance Analysis

Communication Skills

Organizational Skills

Computer Skills

Contract Evaluation

Education

High School Diploma

College Credits or Degree

Tools

State Based Systems

NIPR

Job description

Mission Statement:

The mission of the State of South Carolina Department of Insurance is to protect insurance consumers, the public interest, and the insurance marketplace by ensuring the solvency of insurers; by enforcing and implementing the insurance laws of the State; and by regulating the insurance industry in an efficient, courteous, responsive, fair, and equitable manner. For more information about working at the SC Department of Insurance, please visit Department of Insurance, SC - Official Website | Official Website.

This position is located in the Office of Financial Regulations & Solvency's PBM Oversight & Special Licensing Division.

Job Purpose

Under limited supervision, the employee processes license applications for PBMs, PSAOs, premium service companies, service contract providers, third-party administrators, utilization review/private review agents, and other entities under the Office of PBM Oversight and Specialty Licensing. The employee ensures compliance with insurance statutes, regulations, and rules related to these licenses. Reviews and responds to complaints and external reviews filed against these license types.

Job Functions

1. Licensing and Application Processing: Timely process paper and online licensing and appointment applications (initial and renewal) for various entities. Ensure applications are complete and meet legal requirements. Update relevant information and use systems like the State Based Systems and NIPR.
2. External Relations: Respond to public inquiries, assist with monitoring activities, and prepare for meetings and presentations.
3. Complaint Oversight: Review and investigate complaints against PBMs and PSAOs, ensure compliance, and update tracking systems.
4. External Review Oversight: Review external reviews, gather information, ensure compliance, and assign reviews to IROs.
5. Program Evaluation: Assist in reviewing and updating programs, policies, and procedures to improve efficiency and accuracy.
6. Other Duties: Perform additional tasks as assigned by the supervisor.

Minimum Requirements: High School diploma and relevant experience. Ability to work independently, interpret laws, organize tasks, communicate professionally, and have strong computer skills. 3+ years of direct experience with PBMs, PSAOs, TPAs, or related fields. Ability to analyze contracts and evaluate responses.

Additional Information: Must be able to sit for extended periods, possibly travel overnight, and demonstrate understanding of pharmacy-third-party payer relationships and investigative techniques.

Educational Credentials: College credits or degrees require official transcripts upon employment offer.

Equal Opportunity Employer: Committed to providing equal employment opportunities regardless of race, color, religion, national origin, sex, disability, or age.

Veteran Preference: Priority employment for Veterans.

Benefits Include: Health insurance, leave days, holidays, retirement plans, counseling services, flexible schedules, gym access, growth opportunities, and workplace programs.