Pharmacy Operations Analyst

Internal Reference Number: R1049679. Summary

Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Provides key operations support and guidance on the Pharmacy Benefit Management (PBM) Support Team. Serves as an operations liaison to ensure high levels of service are delivered. As a subject matter expert in the Pharmacy Benefit Management (PBM) benefit administration, this position will drive identification and resolution of issues by partnering with our internal and external customers and our PBM.

This is a remote position, from 8:30am - 5pm Monday through Friday.

• Assist PBM Operations Manager with primary objectives to lead PBM related services including partnership with Pharmacy Support, Management, and Marketing representatives. Provides strategic planning and account management for accounts.
• Support escalations as required within various teams, assisting to hold PBM vendor accountable. Ensure holistic solutions are developed. Makes recommendations for improvements to meet customers' expectations.
• Partner with PBM's Operations areas to drive resolution of issues and process gaps including root cause analysis, mitigation and issue prevention. Streamline operational processes and support development, management and compliance of standard operating procedures. Interfaces with operations to ensure smooth delivery of services.
• Partner with PBM on IT development efforts to streamline operational efficiencies. Participates in efforts to support standardization across accounts and works in multi-disciplinary teams to design and implement product and operational enhancements.
• Manages the new and renewal implementation process for accounts. Maintains ongoing account relationships at multiple levels throughout the organization. Provides both on-site and off-site customer service, which may include interpreting plan design, researching and resolving phone and written inquiries, resolving claims, benefit and enrollment issues. Coordinates open enrollment meetings, renewal processes, and training sessions. Develops implementation processes and manages reporting processes to ensure client retention and high levels of account satisfaction.

• Required
  
  Education:
  
  Bachelor's
• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
• Work Experience: 5 years Health Plan, Pharmacy or PBM Experience.
  5 years of Account Management Experience (may be concurrent).
• Skills and abilities: Strong oral and written communication skills. Strong negotiations skills. Ability to prioritize work and meet deadlines. Ability to work in a self-motivated environment with limited supervision. Understanding of Fully Insured and ASO benefit set-up, including integrated near real time transactional processes. Previously demonstrated interaction with or understanding of IT systems, processes and testing protocols.
• Software and other tools:Microsoft Office

• 5 years of pharmacy benefit management operations or account management experience working at a PBM or health plan.
• Previous demonstrated experience working with large health plan.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Blue Cross Blue Shield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment…