At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.What you'll do:
Pharmacy Benefit design coordination with internal departments and PBM. This includes collaborating with internal teams and the PBM to ensure that pharmacy benefits are submitted, set up efficiently and accurately per the customers’ requirements, perform quality assurance, and researching new or different pharmacy benefits with the PBM. Additionally, ensuring the ACA pharmacy template is completed accurately and timely.
Assurance of accurate and timely pharmacy benefit administration ensuring all new or edited benefits are properly tested, including complex benefit designs.
Support internal team inquires related to pharmacy benefits (i.e., providing direction to teams on supporting and implementing pharmacy benefits, researching and answering complex pharmacy benefit questions).
Research and resolve complex pharmacy benefit issues in coordination with PBM.
Assist with mailings, standard reports, tasks required to properly administer pharmacy benefits. This can include communication to CSC and Marketing of new programs and benefits that impact members and/or groups.
Meeting internal and external (if applicable) service level agreement metrics to meet and exceed customer expectations.
As needed, perform non-clinical reviews of all submitted forms ensuring that all pertinent information is received either in a written or verbal format. This can include obtaining additional information from providers via outbound call to office staff.
To be considered for this position, you must have:
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.
The strongest candidates for this position will also possess:
Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.
We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.