Pharmacy Vendor Coordinator

Description Role Snapshot The Pharmacy Coordinator will oversee development and execution of audit processes that monitor delegated activities performed by the Pharmacy Benefits Manager (PBM). The role will build working expertise in the PBM's online claims system and its capabilities, serving as a knowledgeable resource for the Health Services Contract Center and other internal teams to determine appropriate actions to resolve escalated customer issues. 75-78k, pay may fluctuate based on experience. We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin How do I know this opportunity is right for me? If you enjoy the following: - Serve as the primary subjectmatter expert for internal teams on pharmacy benefits and system capabilities, exercising independent judgment to guide internal teams and resolve highly complex or escalated customer issues. - Interpret pharmacy claims and utilization data, evaluate trends, and determine appropriate actions to address emerging issues or performance gaps. - Make decisions regarding PBM operational needs, partnering with PBM to maintain performance-monitoring processes, resolve discrepancies and manage escalating vendor concerns. - Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to enhance organizational, determining the most effective educational materials - Coordinate PBM employer group reporting and support external customer discussions, interpreting pharmacy trends and benefit design to provide clear guidance and recommendations. - Work with Risk Management to evaluate high-cost claims and determine actions for Short Term Health Plan denials. - Assist Plan Product and related departments with mask configuration and system research, exercising judgment when deciding how to partner with the PBM on benefit or system updates. - Coordinate with PBM and pharmacy vendors to gather and review materials for presentations to Quality Improvement Committee (QIC), including analyses of program performance, pharmacy policies, vendor performance, and audit requirements. - Quantify savings and outcomes for pharmacy programs, evaluating results and determining opportunities for process improvements or cost reductions. - Other duties as assigned Minimum Qualifications - High school diploma and work-related experience. - 5 or more years in a Pharmacy Benefit role, working for a Health Insurer, Pharmacy Benefit Manager, or equivalent - Knowledge of health benefits insurance carrier concepts, pharmacy benefit management operations, terminology, and relevant regulatory standards (URAC, CMS, state). - Understanding of pharmacy claims processing, formulary management, and basic utilization review workflows. - Excellent communication and strong relationship management skills with internal and external partners. - Strong analytical and problem-solving skills, - Strong attention to detail skills, and ability to manage multiple priorities. Preferred Qualifications - Associate's degree in business, healthcare, or related field, Remote Work Requirements - High speed cable or fiber internet. - Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net). - Please review Remote Worker FAQs for additional information. Benefits