Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits, you will be part of an organization committed to offering custom self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency and customer support. We are now a subsidiary of Health Care Service Corporation, the largest customer-owned insurance company in the United States and a strategic partner of Health Benefits since 2018, giving us access to increased national scale and support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration and service to our communities.

Summary: In this position you will act as the primary relationship manager between key client and contracted Pharmacy Benefit Manager (PBM). This will have a key role in recommending, implementing, and supporting existing and changes to their pharmacy programs, handling escalated issues relating to their pharmacy benefits and supporting day to day interfaces. This role will assist Director of Pharmacy Strategies with contract maintenance. You will also work closely with all contracted Pharmacy Benefit Managers and contracted networks to assure that new and existing legislations/regulations are implemented or updated.

Responsibilities:

Pharmacy Specialist

• Contract maintenance
  • Working with Director and Pharmacy Consultant, recommend and facilitate needed changes to contract terms or pricing for key client.

• Product enhancements
  • Provide product development for pharmacy programs that will result in a more cost-effective product, administrative efficiencies, or an enhancement of current benefits for key client.
  • Research potential new solutions/vendors for Key Client providing data/analytics when needed and provide proposal to Key Client and internal teams on suggested implementation.

• Oversee assigned projects/programs for key client and assure project completion in accordance with project management guidelines or other formats.
  • Follow-up as required to maintain the clinical/financial benefits of the original project goals.

• Oversight of the various components and program features comprising their pharmacy offerings.
  • Maintain accuracy of the program/contract intent and analyze pharmacy data tracking and reporting systems to ensure each programs continued effectiveness.
  • Recommend termination of programs no longer suited to the Division based on market review and analysis.
  • Facilitate all formulary changes required by the PBM. This includes documentation of changes, member communications and updating of Key Client custom documents.
• Act on and resolve any escalated key client pharmacy operational issues (eligibility, new account set up, benefit/coverage) in a timely manner.
  • Effectively communicate the issue and expected outcome to all involved parties
  • Assure timelines are adhered to
  • Support of any needed customer communications when appropriate
• Handle day-to-day operational interfaces with Key Client and contracted PBM by each functional area (benefits, sales, client management, etc.).
  • Participate in weekly and quarterly meetings to assure issues are resolved and/or strategies are being developed for the success of the relationship

Compliance Specialist:

• Work with compliance analyst to understand/interpret legislative changes to determine applicability to networks and PBMs
• Work with all preferred PBMs to assure their compliance to the needed change
• Work with all preferred Networks to assure their compliance to the needed change
• Update internal systems with accurate notes and status until completion
• Adhere to required timelines
• Effectively communicate any changes to internal constituents
• Complete any required (monthly/state level) reporting required by legislation requirements.

Qualifications:

• A minimum of 2-5 years of experience working with benefit administration, compliance or PBM industry with deep knowledge of Health Benefits systems and business.
• Must be able to travel one to three times per year entailing one to three nights per trip.
• Proven ability to build relationships with multiple individuals and functions and quickly establish credibility.
• Must have superior written, verbal, collaboration and interpersonal communication skills with the ability to explain complex processes and procedures.
• Requires a Customer Services skill set and mindset.
• Ability to make good decisions and to explain decision-making process.
• Ability to carry out instructions provided in written, oral or diagram form.
• Exceptional organizational skills and attention to detail, as well as a high degree of creativity, flexibility and self-direction
• Resourceful in the ability to identify and obtain new sources of information
• Ability to work independently, problem solve, and make decisions with limited supervision
• Demonstrated ability to plan, prioritize, coordinate and manage projects in a deadline-sensitive environment

Come join Health Benefits! Join a team that will not only utilize your current skills but will enhance them as well. Benefits include health/dental/vision, life insurance, FSA, and HSA, 401(k) plan, Employee Assistant Program, Back-up Care for Children, Adults and Elders and many health and wellness initiatives.

If you are a Colorado resident and this role is a field-based or remote role, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran, or disability.