BlueCross BlueShield of North Carolina Commercial Pharmacy Operations Administrator in Durham, North Carolina

Job Description

Leads the process within Corporate Pharmacy to administer Commercial pharmacy benefits for individual and group offerings either directly or indirectly through the oversight and monitoring of our vendor relationship with the Pharmacy Benefits Management Company (PBM). Participates in corporate projects that involve commercial pharmacy benefits and leads the process to implement within Corporate Pharmacy.

• Works closely with Sr. Pharmacy Operations Administrator for the design and implementation of BCBSNC’s pharmacy benefits.

• Provides support to the Pharmacy Coordinator(s) on escalated and/or complex issues.

• Works closely with Sr. Pharmacy Operations Administrator on annual corporate project to refresh of individual and group pharmacy benefit offerings.

• Maintains project plan documents and provides periodic updates to management on a regular basis, meeting required project deadlines.

• Corporate Pharmacy operational lead for web updates; includes and PBM web sites; includes product/benefit updates and maintenance.

Audits all prescription drug benefit plans built by Pharmacy Coordinators.; Audit includes benefits set up in the BCBSNC and PBM system. Partners with Sr. Pharmacy Operations Administrator, Commercial Pharmacy Program Manager and Pharmacy Services Coordinator to work with PBM in meeting our clients’ needs.

• Support/Collaboration with Corporate Pharmacy Compliance Officer to ensure complete compliance with state and federal regulations for commercial plans. Monitors and facilitates resolution of compliance issues from an operational perspective and provide appropriately timed updates for upward dissemination.

• Engages with other staff members and the PBM client engagement team in activities focused on client retention and new sales, and analysis and resolution of group or individual benefit issues identified by corporate business partners or through internal/external audit.

Hiring Requirements

• Bachelor’s degree.

• 5 years experience in the areas of benefit administration and/or the operations of health care benefits to include responsibilities for managed care benefits administration or healthcare regulatory / compliance related activities.

• Program management and/or project support experience.

• Excellent communicator.

• In lieu of Bachelor’s degree, a minimum of 7 years of experience in the administration and/or operation of health care benefits to include responsibilities for managed care or compliance related activities.

Hiring Preferences

• Experience with pharmacy benefits

• Proficiency in Microsoft Excel, PowerPoint, Word, and Access

• Vendor management and oversight experience

• Time management skills to keep goals and objectives of program on schedule.

• Communication skills to deal with various stakeholders, team members, sponsors, managing directors, customers, vendors, senior management, providers

• General Management skills to manage the resources of the program (financial, vendors, processes, projects).

• Knowledge in the area of programs managed.

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.