Pharmacy Operations Support Specialist (Open to Pharm. Benefits Coordinator level)

Wellmark Blue Cross and Blue Shield - Des Moines, IA

Full-time - Entry Level

Des Moines, IA

Insurance Carriers and Related Activities

About the position

The Pharmacy Operations Support Specialist at Wellmark, Inc. plays a crucial role in supporting the Pharmacy team by coordinating, researching, and resolving inquiries related to pharmacy operations. This position involves providing technical and administrative support to various internal teams, assisting with the maintenance of pharmacy programs and formulary, and ensuring effective communication with stakeholders. The role is designed for individuals who are organized, detail-oriented, and eager to learn in a dynamic environment.

Responsibilities

• Research and respond to inquiries; support other Pharmacy Team members with complex inquiries.
• Assist Pharmacy Analyst - UM & Formulary with developing and maintaining code sets for all therapeutic classes with UM programs.
• Identify member disruptions resulting from formulary or UM changes, benefit changes, and new group implementations.
• Keep the formulary web tool, benefit drug lists, and drug policies up to date.
• Assist with Pharmacy & Therapeutics (P&T) Committee related activities.
• Manage independent review organization (IRO) requests for a non-formulary drug intake process.
• Perform outreach calls to members, pharmacies, and providers related to IRO decisions.
• Communicate with members and providers regarding IRO request outcomes.
• Apply member engagement philosophies and personality-based resolution techniques to all interactions.
• Review and update Frontier Knowledge articles in accordance with regulatory requirements.

Requirements

• High school diploma or GED.
• 1+ year of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service, or similar environment.
• Knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools.
• Ability to develop professional customer relationships by listening and responding to customer needs.
• Knowledge of applicable regulatory standards and internal guidelines.
• Effective critical thinking and analysis skills.
• Strong written and verbal communications skills.
• Excellent decision making and problem solving abilities.
• Strong interpersonal skills with the ability to build collaborative relationships.
• Proficiency with Microsoft Office.

Nice-to-haves

• Associate's degree.
• Certified Pharmacy Technician.
• Prior experience working in a production environment with quantity and quality goals.
• Experience with systems analysis or testing, including writing and executing test cases.
• Knowledge of drug coding and concepts (i.e. NDC, GPI, J codes).

Benefits

• Health insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development opportunities