Pharmacy Operations Specialist

Job Description Operational Execution Execute pharmacy operational processes and activities within an assigned line of business.

Support implementation of pharmacy benefit, communication, and operational changes.

Perform operational tasks accurately and within established timelines.

Maintain adherence to departmental procedures, controls, and service standards.

Benefit Administration Support Working knowledge and understanding of HMSA's drug benefit and different lines of business

Interpreting requirements and impact analyses and benefit testing to validate accuracy and intended results

Analyzes and assess business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency

Support benefit configuration validation, testing activities, and implementation readiness efforts.

Review operational outputs to identify discrepancies, issues, and/or data concerns.

Assist with documentation and maintenance of operational procedures and process materials.

Support activities associated with pharmacy benefit administration and operational execution.

Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review

Issue Identification & Resolution Support Identify operational issues, discrepancies, or process breakdowns during routine activities.

Identifying and assessing operational issues; determining basis for concern

Applying judgement to address issues within established scope and determine when escalation or guidance is needed

Escalate issues requiring analyst, pharmacist, and/or leadership review.

Assist with gathering information and documentation needed to support issue investigation and resolution.

Participate in implementation and remediation activities as directed.

Member Experience & Communication Support Support operational activities impacting members, pharmacies, and/or internal stakeholders.

Assist with execution and quality review of pharmacy-related communications.

Help ensure operational processes support a positive and consistent member experience.

Monitor assigned activities for potential member impact and escalate concerns appropriately.

Continuous Improvement & Team Support Identify opportunities to streamline operational workflows and improve efficiency.

Participate in process improvement efforts and operational readiness activities.

Support cross-training initiatives and maintain knowledge of multiple operational processes.

Contribute to a collaborative and service-oriented team environment.

Performs all other miscellaneous responsibilities and duties as assigned or directed.#LI-Hybrid

Job Requirements Bachelor's degree and two years of related work experience or an equivalent combination of education and related work experience.

Strong organization and time management skills to work on multiple tasks and/or projects simultaneously and meet deadlines and implementation time frames.

Proficiency in issues identification, resolution, and program operations

Basic working knowledge of Microsoft Office applications, including Word, Excel, Outlook, PowerPoint.

Job Details Job Type: Full-time Category:
Administrative / Clerical