Summary
 

We are currently hiring for a Pharmacy Operations Analyst to join BlueCross BlueShield of South Carolina. In this role as a Pharmacy Operations Analyst, you will provide 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.

Description
 

Location:

This position is full-time (40 hours/week) Monday-Friday from 8:00 am – 5:00 pm ET and can be hybrid or fully remote depending on the candidate’s residing location.

What You’ll Do:

• 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.

To Qualify for This Position, You'll Need the Following:

• 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

We Prefer That You Have the Following:

• 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.
• Previous Medicaid experience and