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The Pharmacy Services Specialist coordinates daily pharmacy benefit management operations and supports the development and implementation of pharmacy programs. They also resolve escalated customer service inquiries, pharmacy claim adjustments, and coverage determinations in collaboration with internal and external stakeholders.
Job Description
Job Description SummaryWhat 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
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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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
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