Pharmacy Operations Support Specialist (Open to Pharm. Benefits Coordinator level) - Wellmark, Inc.

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Are you interested in growing your career in the Pharmacy space? Use your strengths at Wellmark! 

About the role: As a Pharmacy Operations Support Specialist, you will provide support to the Pharmacy team by coordinating, researching, and resolving inquiries through multiple channels. You will provide technical and administration support to various teams (Customer Service, Sales, etc.), and assist with reoccurring administrative functions necessary to update and maintain the pharmacy programs and formulary for Wellmark. This includes, but is not limited to, partnering with Pharmacy team members and other internal teams to identify impacted members, update drug lists, perform quality review of benefits, and analyze decisions to determine the effectiveness of the program.  

About you: You are a hyper-organized and highly efficient individual that isn't afraid to learn and take on something new. You are a strong communicator, both verbally and in writing, and are skilled in effectively educating others on processes and procedures. You understand that getting the details right matters, and thorough in your work. You are a self-starter and see yourself as being resourceful and tech savvy, always jumping to learn something new. You enjoy working in an environment that isn't always defined or straightforward and can vary each day - working 'in the gray' is exciting to you.  

If you are excited about a new challenge where you can grow your skills and learn more about the pharmacy side of health insurance, apply for this opportunity today! 

This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option. 

Preferred Qualifications:

• Associate’s degree.
• Certified Pharmacy Technician.
• Prior experience working in a production environment with quantity and quality goals.

Required Qualifications - Pharmacy Operations Support Specialist:

• HS diploma or GED.
• 1+ year of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service, or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
• Ability to proactively develop professional customer relationships by listening, understanding, anticipating and responding with solutions to customer needs.
• Knowledge of applicable regulatory standards, accreditation standards and internal guidelines (e.g., NCQA or UM standards); remain current and consistent with the standard pertinent to pharmaceuticals.
• Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
• Strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
• Effectively resolves issues and conflicts in a professional manner while maintaining composure and confidence. Displays empathy and discerns stakeholders true intent.
• Excellent decision making and problem solving abilities.
• Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas.
• Proficiency with Microsoft Office. Technical aptitude to learn new software quickly.
• Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment. Flexible and adaptable to change.

Additional Required Qualifications for Pharmacy Benefits Coordinator level:

• Associate's degree or direct and applicable work experience. 
• Experience with systems analysis or testing to include writing and executing test cases.
• Knowledge of drug coding and concepts (i.e. NDC, GPI, J codes, MediSpan, etc.).
• Ability to perform, document, and or guide others through a series of related steps and takes action to improve existing conditions and processes
• Ability to identify issues or inconsistencies; obtains relevant information, relates and compares data from different sources and identifies alternative solutions.
• Strong interpersonal skills with the ability to build relationships of collaboration and trust.  Viewed as a subject matter expert and go-to resource.
• Strong collaboration skills, with the flexibility to adapt to different stakeholders
• Proficiency with Microsoft Office, including Excel; use of pivot tables, charts, and formulas is preferred. Technical aptitude to learn new software quickly.

What you will do as a Pharmacy Operations Support Specialist:

a. Research and respond to inquiries; support other Pharmacy Team members with complex inquiries. Provide timely responses to inquiries to Customer Service, Case Management, Network, Sales, Marketing, and other internal departments.

b. Assist Pharmacy Analyst - UM & Formulary with developing and maintaining code sets for all therapeutic classes with UM programs; including supporting PA programs and updating claims guidelines.

c. In coordination with Pharmacy Analyst - UM & Formulary and Pharmacy Operations Coordinator, identify member disruptions resulting from formulary or UM changes, benefit changes, and new group implementations.

d. Assist Clinical Pharmacy Team and Pharmacy Analyst - UM & Formulary with keeping the formulary web tool, benefit drug lists, and drug policies on the web up to date.

e. Assist Clinical Pharmacy Team and Pharmacy Analyst - UM & Formulary with Pharmacy & Therapeutics (P&T) Committee related activities.

f. Manage independent review organization (IRO) requests for a non-formulary drug intake process and coordinate member and provider communications as a results of IRO decision.

g. Perform outreach calls to members, pharmacies, and providers related to IRO decisions. Provide value-based customer experience through active listening and responding accurately, promptly, and professionally to member and provider questions. 

h. Communicate with members and providers that results in accurate understanding of IRO request outcomes. Ability to express complex concepts clearly and concisely. Manage difficult conversations that result in escalated interactions with professionalism and composure.

i. Apply member engagement philosophies and personality-based resolution techniques to all interactions. Integrate Wellmark’s basic customer experience principles into day-to-day interactions. Anticipate members’ needs to make it easy to do business with Wellmark.

j. Work in coordination with internal teams in reviewing and updating Frontier Knowledge articles as need in accordance with regulatory requirements, BCBSA guidelines, and other internal processes as needed.

k. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".