Pharmacy Benefit Manager Operations Analyst

Blue Cross Blue Shield of Minnesota•Eagan, MN

2d•Hybrid

About The Position

The Pharmacy Benefit Manager Operations Analyst establishes and refines operational processes related to CMS and state requirements for Medicare products. The role develops an oversight structure for Pharmacy Benefit Manager (PBM) departmental and key stakeholder activities, including KPIs and program dashboards to measure performance. The analyst manages and oversees aspects of PBM and other vendor operations, including Medicare Part D requirements and related processes such as member escalation management, pharmacy claims analysis, and reporting. The role also drafts and maintains policies related to its core responsibilities and works with internal and external partners, clients, and vendors to manage and resolve inquiries, issues, and requests for information. This position is hybrid, with a minimum of two days onsite each week and the remainder of the week remote. Compensation is listed as $68,900.00–$113,700.00 annually, with pay based on factors including the selected individual's skills, ability, and knowledge.

Requirements

At least 3 years of related health services professional experience.
Bachelor’s degree, or an additional two years of relevant experience beyond the listed qualifications in lieu of a degree.

Nice To Haves

Ability to tailor communication to varied audiences, actively listen to uncover requirements, and ensure accurate and timely information exchange.
Ability to analyze information, identify patterns and root causes, and collaborate with partners to implement practical solutions.
Ability to leverage technology to tailor communications, uncover needs, analyze root causes, and collaborate on practical solutions.
Curiosity and willingness to use emerging technologies, including artificial intelligence and automation tools, to improve operational efficiency, data analysis, reporting, and decision-making.
Ability to organize work, balance competing priorities, and manage time across multiple responsibilities and deadlines.
Experience and knowledge of pharmacy operations, including PBM, health plan, retail, specialty, or medical pharmacy.
Experience triaging and resolving inquiries associated with claims and benefits.
Experience working with Medicare.
Experience working with members, clients, or patients by phone.
Demonstrated project management and strategy development skills.

Responsibilities

Establish and refine operational processes related to CMS and state requirements for Medicare products.
Develop oversight structures for PBM departmental and key stakeholder activities.
Establish KPIs and program dashboards to measure performance.
Manage and oversee aspects of PBM and other vendor operations.
Manage and oversee Medicare Part D requirements and corresponding operational processes, including member escalation management, pharmacy claims analysis, and reporting.
Draft and maintain policies related to core job responsibilities.
Collaborate with internal and external partners, clients, and vendors.
Intake, manage, and resolve inquiries, issues, or requests for information from members, groups, clients, CMS/DHS, and other channels.
Perform additional responsibilities consistent with the scope and level of the role, as assigned.