The Pharmacy Management at BlueCross BlueShield of Tennessee (BCBST) is seeking a motivated, detail-oriented Pharmacy Analyst II to join our team and support pharmacy operations across Commercial and Marketplace lines of business.In this role, you’ll play a critical part in PBM (Pharmacy Benefit Manager) 1/1 readiness by ensuring pharmacy benefits are accurately configured and validated before go-live, while also investigating service disruptions, driving process improvements, and coordinating cross-functional initiatives with clinical, IT, finance, and vendor partners.
This position requires strong critical thinking, attention to detail, and the ability to navigate complex environments—helping protect member experience and support regulatory compliance across real-time claims operations.Success in this role requires: Demonstrated experience supporting or overseeing healthcare contracts, with the ability to interpret and apply benefit and reimbursement terms.Strong analytical capabilities, including running reports, validating data, and researching complex operational issues.Prior experience working with a Pharmacy Benefit Manager (PBM), including auditing, benefit validation, or claims review.Note:This is a fully remote role, but travel to our Chattanooga, TN headquarters for final interviews may be required.Although we are based in Chattanooga, TN, this is a fully remote role.Sponsorship is not available for this position.At BCBST, we foster a culture where innovation is encouraged, including the responsible use of AI-enabled tools to support everyday work.
As roles become more advanced, employees are expected to leverage AI, guided by established workflows, templates, and policies, to improve how we serve our members.Job ResponsibilitiesImplement business strategies aimed at improving processes, ensuring they are completed on time and within scope.Issue Investigation: Lead investigations into service disruptions or inefficiencies, applying structured problem-solving to recommend practical solutions.Process Improvement: Collaborate across teams to identify and implement workflow enhancements that improve efficiency and accuracy.Initiative Coordination: Coordinate with internal teams (e.g., clinical, IT, finance, vendor management) to support pharmacy-related initiatives and program interdependencies.Compliance: Maintain a working knowledge of pharmacy regulations and ensure data and processes align with compliance standards.Professional Development: Share knowledge within team learning sessions and onboarding activities.
Project Management: Manage various workstreams in strategic projects, ensuring alignment with pharmacy business objectives and stakeholder expectations.Job QualificationsEducationBachelor’s degree or equivalent work experience required.
Equivalent work experience is defined as 4 years of professional work experience.ExperienceMinimum 4 years Healthcare Industry experience required Minimum 3 years of experience in a related field such as operations, technical, project management, product or other related field required.Skills/CertificationsAbility to evaluate programs and operational processesSkill in issue investigation and structured problem-solvingExpertise in workflow improvement and efficiency enhancementsStrength in coordinating initiatives across internal teamsCapability to ensure compliance with regulatory standardsNumber of Openings Available1Worker Type:EmployeeCompany:BCBST BlueCross BlueShield of Tennessee, Inc.Applying for this job indicates your acknowledgement and understanding of the following statements:BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:BCBST's EEO Policies/NoticesBlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.
All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered.
No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Originally posted on Himalayas
Cargando...