Medicare Pharmacy Operations Analyst

BlueCross BlueShield of South Carolina
life insurance, paid time off, tuition assistance, 401(k)
United States, South Carolina, Columbia
Nov 08, 2024
Summary We are currently hiring for a Medicare Pharmacy Operations Analyst to join BlueCross BlueShield of South Carolina. In this role as a Medicare Pharmacy Operations Analyst, you will provide key operations support and guidance on the Pharmacy Benefit Management (PBM) Support Team and serve 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. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Logistics This position is full time (40 hours/week) Monday-Friday and will be 17 Technology Circle, Columbia, S.C., 29203. What You Will 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 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 Will Need: Bachelor's Degree. Four years job-related work experience OR Associate's and two years job-related work experience. Five years Health Plan, Pharmacy OR PBM Experience. Five years of Account Management Experience (may be concurrent). 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. Microsoft Office. What We Prefer: Five 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. Excellent Microsoft Excel skills. Experience with a data analysis tool such as Microsoft Access, DB2, SQL, Data Lake, Tableau, OR similar tool. What We Can Do for You We offer our employees great benefits and rewards.You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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. Wellness program and healthy lifestyle premium discount. Tuition assistance. Service recognition. Employee Assistance. Discounts to movies, theaters, zoos, theme parks and more. What to Expect Next After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.This may include a brief telephone interview OR email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application. Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.