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Job Description
Job Description Summary
We're hiring a Pharmacy Services Specialist to assist in the development and management of pharmacy benefit administration for current and new plan designs or products. Provides daily coordination of activities related to operations of pharmacy benefit management or nonclinical review and call center support. Serves as subject matter expert for current processes and new initiatives.
What You'll Do
Provides daily coordination of activities related to operations of pharmacy benefit management. Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives. Serves as resource to staff and subject matter experts assigned initiatives to provide input regarding pharmacy needs, impacts and projects. Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues. Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team. Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate. Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate. Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.
What You Bring
Bonus Points (preferred qualifications)
Strong communication and interpersonal skills. Excellent time management and organizational abilities. Proficiency with Microsoft Office Suite Must be able to work weekends and holidays as needed to support business and operational requirements.
WhatYou'llGet
The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community Work-life balance, flexibility, and the autonomy to dogreat work Medical, dental, and vision coverage along withnumeroushealth and wellness programs Parental leave and support plus adoption and surrogacyassistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $45,761.00 - $73,217.00
Skills _____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
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Blue Cross and Blue Shield of North Carolina
$45,761.00 - $73,217.00
parental leave, paid time off, tuition reimbursement, 401(k)
Sep 01, 2026