Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

· Responsible for supervising and managing functions and all vendors that support benefits for prescription drugs

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 10 years of experience in pharmacy or medical claim field

· 2 years of experience with the current BCBSAZ PBM system or previous system

· 5 years of experience working with PBM Sales support

2. Required Education

· Associate Degree in Business Administration, HealthCare Administration or related field

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 12 years of experience with a pharmacy benefit management or prescription claim administration company

· 5 year of experience with the current BCBSAZ PBM system

· 1 year experience with BCBSAZ claims software / system

· 3 years of demonstrated experience handling confidential information

· 3 years of experience supporting Sales/RFP and Client Implementation needs

2. Preferred Education

· Bachelor of Science Degree in Business Administration, HealthCare Administration or related field

3. Preferred Licenses

· N/A

4. Preferred Certifications · N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Supports the Sales/RFP and CIM teams to ensure they have what they need from our pharmacy team to do the following

o Respond to RFPs, this includes coordinating all updates to the RFP library and ensuring accurate pricing to

clients is available for RFPs.

o Responds to issues from sales from clients or brokers about our pharmacy benefits.

o Communication contact for all things pharmacy i.e., updates to benefits, benchmark questions etc.

o Supports creation of new pricing modes (variable pricing) for clients.

o Supports implementation and monitoring of all variable pricing clients including accuracy of said pricing

o Participate in pre-Sales meetings/discussions to better understand the opportunity and how to best position

our response

o Coordinates PBM specific files with appropriate vendor(s)

o Coordinate internal requests to SME’s to generate coverage disruption files.

o Runs initial reports needed to request business impact for buy-up programs supported by vendor(s)

o Coordinate impact report requests with appropriate vendor(s)

o Review and respond with observations to Sales SRE’s/AM’s about benefits of prospective buy-up programs.

o Coordinates review/distribution of buy-up program reporting to applicable SRE’s/AM’s.

o Works collaboratively with PA Techs/Pharmacists to coordinate requests to/from Sales for coverage

exceptions and ensures group level impacts are clearly known/agreed to.

· Supports the RFP process and coordinate distribution of questions to vendor when appropriate.

· Administer, interpret and maintain current knowledge of the required BCBSAZ systems, procedures, forms and manuals

· Create and Communicate recommendations in regard to medication claim processing.

· Monitor, investigate and report on reported medication related claim system issues

· Participate in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and

concerns, and creation and implementation of corrective actions as requested

· Actively participate in activities which support PBM services that offer the best value and compete actively in the market

· Communicate effectively with the management team within the department to investigate, strategize, troubleshoot, and

streamline processes

· The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any

additional hours as requested or as needed to meet business requirements.

· Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Intermediate PC proficiency with word processing, spreadsheets (Excel), and claims and imaging software

· Intermediate skill in use of office equipment, including copiers, fax machines, scanners, and telephones

2. Required Professional Competencies

· Take initiative

· Flexibility in prioritization of workflow

· Maintain confidentiality and privacy

· Establish and maintain working relationships in a collaborative team environment

· Capable of teaching and confirming proficiency of delegated skills

· Analytical knowledge necessary to make or advise on moderate to high impact decisions

· Compose a variety of business correspondence

· Ability to compose clear/concise responses for RFP responses

3. Required Leadership Experience and Competencies

· N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

· Advanced skill in the use of office equipment, including copiers, fax machines, scanners and telephones

· Advance PC proficiency

· Advanced word processing, spreadsheet (excel) and database software proficiency

2. Preferred Professional Competencies

· Effective interpersonal communication

· Claim system experience with pharmacy vendor software and/or systems

· Understand workflow systems to maximize resources and streamline processes for efficiency

3. Preferred Leadership Experience and Competencies

· Demonstrate leadership

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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