Pharmacy Operations Specialist

HMSA • Honolulu, HI

3d

About The Position

The Pharmacy Operations Specialist executes pharmacy operational processes and activities within an assigned line of business and supports pharmacy benefit, communication, and operational changes. The role performs tasks accurately and on schedule while following departmental procedures, controls, and service standards.

The position supports pharmacy benefit administration, including benefit configuration validation, testing, implementation readiness, and review of operational outputs. It monitors the accuracy of pharmacy drug benefits through testing, reviews, and validations, and reports monitoring results or live-claim review findings. The specialist also helps identify and investigate operational issues, supports resolution and remediation activities, and escalates matters requiring analyst, pharmacist, or leadership review.

The role supports operational activities and communications that affect members, pharmacies, and internal stakeholders, with attention to member experience. It contributes to process improvement, operational readiness, cross-training, and a collaborative, service-oriented team environment. Other miscellaneous responsibilities may be assigned or directed.

Requirements

• Bachelor's degree and two years of related work experience, or an equivalent combination of education and related work experience.
• Strong organization and time-management skills, including the ability to manage multiple tasks or projects and meet deadlines and implementation timeframes.
• Proficiency in issue identification, resolution, and program operations.
• Basic working knowledge of Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.

Responsibilities

• Execute pharmacy operational processes and activities within an assigned line of business.
• Support implementation of pharmacy benefit, communication, and operational changes.
• Complete operational tasks accurately and within established timelines while adhering to departmental procedures, controls, and service standards.
• Interpret requirements and impact analyses, and conduct benefit testing to validate accuracy and intended results.
• Analyze business problems involving benefit or product changes, formulary changes, system enhancements, or redesigns intended to improve efficiency.
• Support benefit configuration validation, testing activities, and implementation readiness efforts.
• Review operational outputs to identify discrepancies, issues, or data concerns.
• Assist with documenting and maintaining operational procedures and process materials.
• Support pharmacy benefit administration and operational execution.
• Monitor and evaluate pharmacy drug benefit accuracy through testing, reviews, and validations; report monitoring or live-claim review findings.
• Identify and assess operational issues, discrepancies, and process breakdowns; determine the basis for concerns and address them within established scope, seeking guidance or escalating when needed.
• Escalate issues requiring analyst, pharmacist, or leadership review.
• Gather information and documentation to support issue investigation and resolution.
• Participate in implementation and remediation activities as directed.
• Support operational activities affecting members, pharmacies, and internal stakeholders.
• Assist with execution and quality review of pharmacy-related communications.
• Monitor assigned activities for potential member impact and escalate concerns appropriately.
• Identify opportunities to streamline workflows and improve efficiency; participate in process improvement and operational readiness efforts.
• Support cross-training initiatives and maintain knowledge of multiple operational processes.
• Contribute to a collaborative and service-oriented team environment.
• Perform other miscellaneous responsibilities and duties as assigned or directed.

What This Job Offers

• Job Type: Full-time