-
Actuary
3 weeks ago
apree health Not specified, United States Full time· Actuary, Actuarial Services · About the Company · apree health - is seeking an experienced healthcare Actuary to join our Actuarial Services team. · About the Team · The Actuarial Services team is responsible for value-based contracting, financial forecasting, and ad hoc medic ...
-
Territory Sales Manager
2 weeks ago
American Farm Products Inc. Not specified, United States Full timeAmerican Farm Products · Company Description · American Farm Products Inc. was founded in 1982 by William Absalom II, who believed that there was a market for high-quality silage preservatives in the dairy industry. For over 40 years, we have manufactured silage additives and n ...
-
Director, Medicare Product Development
5 days ago
Molina Healthcare Not specified, United States Full timeJOB DESCRIPTION · Job Summary · This position is responsible for supporting development and pricing of Medicare products, which include MA-PD, D-SNP and MMP. · KNOWLEDGE/SKILLS/ABILITIES · The Director Medicare Product Development is a key member of a small team that is responsib ...
-
Insurance Broker
2 days ago
Verum Vitae Financial Group Not specified, United States Full time· Have you ever dreamed of putting together your own team of top-performing insurance agents? If you've got what it takes to become an Insurance Broker on our team, we'll make that dream a reality. You'll have the chance to recruit, train, and develop your agents your way so the ...
-
Actuary Solution Consultant
6 days ago
FIS, Inc. Not specified, United States Full timeJob Description · As the world works and lives faster, FIS is leading the way. Our fintech solutions touch nearly every market, company and person on the planet. Our teams are inclusive and diverse. Our colleagues work together and celebrate together. If you want to advance the w ...
-
Market Underwriter
1 day ago
Highmark Health Not specified, United States Full timeCompany : · Highmark Inc.Job Description : · JOB SUMMARY · This job serves as the single-point-of-contact for sales teams and assigned customers, delivering insights and recommendations to sales in order to aid customer acquisition/retention while maintaining performance goals. ...
-
PL Product Manager
3 weeks ago
Country Financial Not specified, United States Full timeAccountable for product premium volume growth and profitability results within assigned state(s). Geographic area depends on population size and market/regulation characteristics. Manages relationship of every aspect of assigned product through interaction with relevant departmen ...
-
Provider Transformation Specialist
2 weeks ago
Highmark Health Not specified, United States Full timeCompany : · Highmark Inc.Job Description : · JOB SUMMARY · * This is a hybrid role requiring 3 days a week in office or at provider sites. This role supports the Southeastern PA market (SEPA) and will require local travel. · This job is directly responsible for outcomes of pro ...
-
Associate Actuary
2 weeks ago
Aegon Not specified, United States Full timeResponsibilities Builds and maintains experience studies, including data models, actual and expected calculations, and data visualization. · Presents and advocates for results at governance committees to stakeholders including senior leaders, modelers, and risk. · Coordinates ...
-
Senior Medical Stop Loss Underwriter
2 weeks ago
Highmark Health Not specified, United States Full timeCompany : · HM Insurance GroupJob Description : · JOB SUMMARY · This job prices quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of Underwriting authority within the ...
-
Associate Medical Stop Loss Underwriter
6 days ago
Highmark Health Not specified, United States Full timeCompany : · HM Insurance GroupJob Description : · JOB SUMMARY · This job pricies quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent develops and uses discretion of Underwriting author ...
-
Senior Product Manager
6 days ago
OneAmerica Not specified, United States Full timeAt OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are ...
-
Liberty Information Technology Limited Not specified, United States Full timePay Philosophy · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these p ...
-
Liberty Mutual Not specified, United States Full timePay Philosophy · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these p ...
-
Underwriter
2 weeks ago
The Amynta Group Not specified, United States Full timeWe're thrilled that you are interested in joining us here at the Amynta Group · Underwriter · The primary focus of the Underwriter is producing, underwriting and retaining profitable business for the company. With respect to the commercial lines P&C insurance sector, underwriters ...
-
VP - General Liability
3 days ago
The Amynta Group Not specified, United States Full timeWe're thrilled that you are interested in joining us here at the Amynta Group · Purpose of the Job: · VP-Underwriting is responsible for producing, underwriting, managing and retaining profitable business for the company. The primary objective of the VP-Underwriting is to underwr ...
-
Senior Actuarial Analyst
2 weeks ago
Highmark Health Not specified, United States Full timeCompany : · Highmark Inc.Job Description : · Job Description · JOB SUMMARY · This job is a mid-level actuarial analyst position. Participate in Highmark's Actuarial Executive Development Program and is expected to make continued progress towards actuarial credential and apply ac ...
-
Associate Actuary
2 weeks ago
Highmark Health Not specified, United States Full timeCompany : · Highmark Inc.Job Description : · JOB SUMMARY · This job is a senior level actuarial analyst position. Participates in Highmark's Actuarial Executive Development Program and is expected to make continued progress towards actuarial credential. Utilizes experience and i ...
-
Associate Actuary
2 weeks ago
Transamerica Not specified, United States Full timeJob Family · Actuarial · About Us · At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential unleashed by leveraging the talents of a diverse workforce. We embrace an environment where employees e ...
-
Senior Actuary
2 weeks ago
Highmark Health Not specified, United States Full timeCompany : · Highmark Inc.Job Description : · JOB SUMMARY · This is an individual contributor, credentialed actuary position. Participates in Highmark's Actuarial Executive Development Program. Utilizes subject matter expertise and advanced industry knowledge to define & diagnose ...
Sr Director, Pharmacy Contracting and Sales - Not specified, United States - BlueCross BlueShield of South Carolina
Description
Summary
Negotiates pharmacy benefit management (PBM) agreements for retail/mail order/specialty pharmacy services for commercial lines of business. Directs pharmacy sales, renewal activities/request for proposal preparation/current, prospective group presentations/consulting with groups on alternative benefit designs. Monitors contract compliance/financial terms/state, federal regulatory requirements, performance guarantees specific to clinical operational activities.
Description
Conducts contract negotiations. Monitors competitor sales activities and develops our message to counter their sales.
Secures competitive network discounts, various network options, pricing arrangements, and solicits and analyzes bids periodically in order to remain competitive in the marketplace.
Manages pharmacy sales activities to ensure retention and growth of covered pharmacy lives. Analyzes pharmacy data and market trends to develop a pharmacy sales approach. Responds to requests for proposals, gives sales presentations and works with groups in a consulting role.
Oversees the management of the PBM contracts to ensure compliance with the terms of the PBM agreement for all lines of business.
Provides recommendations for the development of additional PBM programs based on market needs.
Works closely with actuarial and underwriting departments in pricing products.
Required Education: Bachelor's in a job related field
Required Work Experience: 10+ years of progressively complex healthcare network development experience to include 2 years of pharmacy contracting experience and either 7 years of management experience in negotiating and maintaining network contracts OR 7 years of equivalent military experience in grade E4 or above.
Required Skills and Abilities: Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills. Excellent analytical and critical thinking skills. Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others. Ability to use complex mathematical calculations. Ability to meet tight deadlines, and adapt to an ever-changing business environment. Able to quickly implement new business requirements without disruption of current responsibilities. Ability to assess both internal and external requirements and reprioritize quickly. Ability to oversee multiple projects simultaneously.
Required Software and Other Tools: Microsoft Office. Knowledge of computer systems support and data extracting.
Preferred Education:
Bachelor's degree-in Business Administration.
Preferred Work Experience: 8 years-of operations or contracting experience with Medicare Part D, analyzing pharmacy claims data. Experience may also be in PBM implementation and contract compliance experience.
Preferred Licenses and Certificates:
Registered Pharmacist
Work Environment:
Typical office environment. Frequent travel.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.
Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans.
It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail or call , ext with the nature of your request.
