Job Description
Job Description SummaryWe’re hiring a Pharmacy Services Specialist to assist in the development and management of pharmacy benefit administration for current and new plan designs or products. Provides daily coordination of activities related to operations of pharmacy benefit management or nonclinical review and call center support. Serves as subject matter expert for current processes and new initiatives.
What You’ll Do
Provides daily coordination of activities related to operations of pharmacy benefit management.
Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives.
Serves as resource to staff and subject matter experts assigned initiatives to provide input regarding pharmacy needs, impacts and projects.
Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues.
Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate.
Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate
Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.
What You Bring
High School Diploma or GED
3+ years of experience in related fields
Bonus Points (preferred qualifications)
Strong communication and interpersonal skills.
Excellent time management and organizational abilities.
Proficiency with Microsoft Office Suite
Must be able to work weekends and holidays as needed to support business and operational requirements.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
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Skills Required
- High School Diploma or GED
- 3+ years of experience in related fields
- Ability to work weekends and holidays as needed
- Strong communication and interpersonal skills
- Excellent time management and organizational abilities
- Proficiency with Microsoft Office Suite
What We Do
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.
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