- Core responsibilities will involve operational management and oversight of the Pharmacy Benefit Manager(s) (PBM).
- Manage, and oversee Medicare Part D requirements and corresponding operational processes. Including, but not limited to: Payment integrity - PDE/Encounter Data, FIR's, NX Transactions, and Coordination of Benefits., coverage decisions and appeals, claims, benefits, formulary/PDL, networks and materials
- Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.
- Draft and maintain policies related to core job responsibilities.
- Collaboratively work with internal and external partners, clients, and vendors.
- Intake, manage, and resolve inquiries, issues, or requests for information received from members, groups, Clients, CMS/DHS and/or any other channel.
- Help prepare and disseminate dashboards and/or reporting associated with PBM oversight.
- Seven (7) years of professional experience in pharmacy at a health plan or PBM.
- Five (5) years of experience in triaging and resolving inquiries associated to claims and benefits.
- Seven (7) years of experience working Medicare Part D and/or Medicaid
- Previous experience in pharmacy technician role, with or without certification
- PBM experience preferred
- Bachelor's degree or equivalent experience
-
Operations Analyst
3 days ago
Powerplay Retail™ St Paul, United StatesWe are looking for Operations Analysts to join our growing team These roles serve as a key player in supporting the operations and sales initiatives of the company. These positions are responsible for daily client management ensuring accuracy of purchase orders, shipping time, he ...
-
Operations Analyst
3 days ago
Equiniti St Paul, United States Regular, Full timeManagement Level · I Equiniti is a leading international provider of shareholder, pension, remediation, and credit technology. With over 6000 employees, it supports 37 million people in 120 countries. · EQ US is a leading provider of ownership data management, analytics and adv ...
-
Operations Analyst
3 days ago
Wold Architects St Paul, United StatesWatch Why Work at Wold to learn more about what makes us a great place to work. · Would you like to be part of a well-established, growing firm in the Twin Cities? · Wold Architects and Engineers, a dynamic, growth-oriented architectural and engineering firm with headquarters i ...
-
Marketing Operations Analyst
3 weeks ago
Dover Corporation St Paul, United StatesThe Marketing Operations Analyst is responsible for designing and conducting marketing and sales funnel measurement and analysis. This role will own the creation and reporting of monthly KPIs and dashboards, as well as perform analysis and build proc Operations Analyst, Marketing ...
-
Operational Risk Analyst
2 weeks ago
Wings Financial Credit Union St Paul, United StatesResponsible for the strategic execution and end-to-end support the WFCU's Operational Risk Management (ORM) program at the enterprise level (second line of defense), specifically to enable the Credit Union to effectively identify, monitor, measure an Risk Analyst, Risk, Business ...
-
Security Operations Analyst
15 hours ago
C.H. Robinson St Paul, United StatesC.H Robinson is seeking a talented Security Operations Analyst to join our Cyber Security team. In this role, you will participate in the attack surface reduction of global computing assets through the identification, prioritization, and remediation of system, network, and applic ...
-
Custody Operations Analyst
2 days ago
U.S. Bancorp St Paul, United StatesDepartment: Wealth, Corporate, Commercial and Institutional Banking (WCIB) Operations - Custody Operations - Global Settlements. Responsible for the management and oversight of Wealth Management & Investment Services (WMIS) client accounts and produc Operations Analyst, Operation ...
-
Marketing Operations Analyst
1 week ago
Dover Corporation St Paul, United StatesAbout CPC · Colder Products Company (CPC), a Dover company, is the world's leading provider of quick disconnect couplings, fittings and connectors for plastic tubing. Used in a broad range of industries and applications, the innovative coupling and connection technologies from C ...
-
Operational Risk Analyst
2 days ago
Wings Financial Credit Union St Paul, United StatesJob Description · Job Description · PRIMARY PURPOSE: · Responsible for the strategic execution and end-to-end support the WFCU's Operational Risk Management (ORM) program at the enterprise level (second line of defense), specifically to enable the Credit Union to effectively id ...
-
Operational Risk Analyst
2 days ago
Wings Financial St Paul, United StatesPRIMARY PURPOSE: · Responsible for the strategic execution and end-to-end support the WFCU's Operational Risk Management (ORM) program at the enterprise level (second line of defense), specifically to enable the Credit Union to effectively identify, monitor, measure and control ...
-
Custody Operations Analyst
3 days ago
U.S. Bank St Paul, United StatesAt U.S. Bank, we're on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each ...
-
Senior Financial Analyst, Operations
1 week ago
Boston Scientific St Paul, United StatesAdditional Location(s): N/A · Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance · At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and high-performing employees, tacklin ...
-
Investment tax operations analyst
1 week ago
Randstad St Paul, United StatesDo you have an educational background in accounting, business administration, mathematics, finance, or economics; along with a passion for domestic/international investments and an interest in learning about the tax ramifications? This role utilizes multiple systems, advanced Exc ...
-
Blue Cross Blue Shield of Minnesota St Paul, United StatesAbout Blue Cross · Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. ...
-
Business Systems Analyst
6 days ago
Dahl Consulting St Paul, United StatesBusiness Systems Analyst - Dynamics 365 F&O · Saint Paul, MN · Direct Hire · Open to Relocation · Position Summary · As a Sr. Business Systems Analyst specializing in accounting operations and proficient in Microsoft Dynamics 365 F&O, this position will play a pivotal role in o ...
-
Open Data Analyst
2 weeks ago
Ramsey County MN St Paul, United StatesAre you passionate about leveraging the power of data to drive transparency, accountability, and engagement? Ramsey County is seeking a dynamic and innovative individual to join our team as an Open Data Analyst (Management Analyst 2) in the Communica Analyst, Data Analyst, Manage ...
-
Sr. Analyst, Transportation
6 days ago
Best Buy Co. , Inc. St Paul, United StatesAs the Transportation Senior Analyst for Middle Mile, youll support Best Buy through the coordination of freight movements and the associated analytics. Youll be responsible for the transportation of freight from Best Buy distribution centers to Be Transportation, Transport, Anal ...
-
Business Process Analyst
1 week ago
Talent Software Services St Paul, United StatesAre you an experienced Business Process Analyst with a desire to excel? If so, then Talent Software Services may have the job for you Our client is seeking an experienced Business Process Analyst to work in Arden Hill, MN. · Position Summary: This position is a member of the cli ...
-
Senior Analyst
4 days ago
Truity Partners St Paul, United StatesSenior Analyst · Our client is an organization in the Hennepin County area looking for a · Senior Analyst . Our client is looking for someone with 4+ years of experience, excellent problem solving and decision-making skills. This company offers growth opportunities and a strong ...
-
Customer Experience Analyst
1 week ago
Thomson Reuters Canada Limited St Paul, United States****Our Privacy Statement & Cookie Policy**** · **Customer Experience Analyst** · The Customer Experience Analyst is a core component of the Customer Experience team at Thomson Reuters. They will help develop and provide the relevant insights to scale initiatives across the ent ...
Senior Pharmacy Benefit Manager Operations Analyst - St Paul, United States - Blue Cross Blue Shield of Minnesota
Description
About Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work?
The PBM Operations Analyst Sr. will focus on establishing and refining operational processes related to CMS and State requirements for Medicare and Medicaid products. This position will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM), departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance.
A Day in the Life:
Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
