Pharmacy Services Specialist

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $45.8k - $73.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Assist in the development and management of pharmacy benefit administration for current and new plan designs or products • Coordinate daily activities related to pharmacy benefit management operations or nonclinical review and call center support • Support staff and coordinate tasks for research, development, implementation, and evaluation of programs, projects, and initiatives • Serve as a resource and subject matter expert regarding pharmacy needs, impacts, and projects • Resolve issues and escalate to management as appropriate • Assist management with clinical and contractual issues • Coordinate review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team • Resolve escalated customer service inquiries and grievances, including researching and authorizing or making pharmacy claim adjustments • Coordinate Pharmacy Coverage Determinations with clinical staff and external partners • Coordinate pharmacy claim reconsiderations and appeals with the Appeals department and external partners • Respond to and coordinate review and approval of RFPs, government program applications, and similar requests

🎯 Requirements

• High School Diploma or GED • 3+ years of experience in related fields • 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

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO)