Program Coordinator I-PBM

State of South Carolina; South Carolina; On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a detail-oriented individual to join their Office of Financial Regulations & Solvency. This role involves processing license applications for various entities, ensuring compliance with insurance laws, and responding to external inquiries. The ideal candidate will possess strong organizational and communication skills, along with a solid understanding of South Carolina's insurance regulations. With a focus on maintaining the integrity of the insurance marketplace, this position offers a unique opportunity to contribute to the public interest while working in a supportive environment. Join a dedicated team committed to excellence and public service.

Benefits

Comprehensive Insurance Options

Paid Leave

Holidays

Retirement Plans

Qualifications

• Minimum 3 years of experience with PBMs, PSAOs, or related fields.
• Knowledge of South Carolina laws and regulations related to PBMs.

Responsibilities

• Process applications for licensing and renewal, ensuring compliance.
• Review and investigate complaints, ensuring compliance with laws.

Skills

Organizational Skills

Communication Skills

Computer Skills

Knowledge of South Carolina Laws

Analytical Skills

Education

High School Diploma

College Credits or Degree

Tools

Microsoft Office

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.

Position Location

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. Ensures compliance with insurance statutes, regulations, and rules. Reviews and responds to complaints and external reviews filed against these license types.

Job Functions

1. Licensing Tasks: Process applications for licensing and renewal, ensuring accuracy and compliance with laws and policies; update relevant information through various systems.
2. External Relations: Respond to inquiries, assist with monitoring activities, and help prepare meetings and presentations.
3. Complaint Oversight: Review and investigate complaints, ensure compliance, and update tracking systems.
4. External Review Oversight: Review external pharmacy reviews, ensure compliance, and coordinate with IROs.
5. Program Evaluation: Assist in reviewing and improving programs, and update policies and procedures.
6. Other Duties: Perform additional tasks as assigned by the supervisor.

Qualifications

• High School diploma and relevant experience.
• Ability to sit for extended periods, occasional overnight travel.
• Knowledge of South Carolina laws and regulations related to PBMs, PSAOs, and insurance.
• Strong organizational, communication, and computer skills; proficiency in Microsoft Office.
• Minimum 3 years of experience with PBMs, PSAOs, TPAs, or related fields.
• Understanding of pharmacy-third-party payer relationships and ability to analyze contracts.

Additional Requirements

• Ability to interpret laws and policies.
• Ability to establish effective relationships and communicate professionally.
• Initiative and sound judgment; ability to work independently.

Educational Credentials

Applicants with college credits or degrees must submit official transcripts prior to employment.

EEO and Veteran Policies

We provide equal employment opportunities and prioritize veteran employment.

Benefits

• Comprehensive insurance options, paid leave, holidays, retirement plans, and more.