Description
Role Snapshot
The Pharmacy Coordinator will oversee development and execution of audit processes that monitor delegated activities performed by the Pharmacy Benefits Manager (PBM). The role will build working expertise in the PBM's online claims system and its capabilities, serving as a knowledgeable resource for the Health Services Contract Center and other internal teams to determine appropriate actions to resolve escalated customer issues.
Salary Range
75-78k, pay may fluctuate based on experience.
Work Location
Employees within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713) will be expected to be able to be able to work Hybrid 2 days a week on a regular basis.
We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you enjoy the following:
Serve as the primary subjectmatter expert for internal teams on pharmacy benefits and system capabilities, exercising independent judgment to guide internal teams and resolve highly complex or escalated customer issues.
Interpret pharmacy claims and utilization data, evaluate trends, and determine appropriate actions to address emerging issues or performance gaps.
Make decisions regarding PBM operational needs, partnering with PBM to maintain performance-monitoring processes, resolve discrepancies and manage escalating vendor concerns.
Collaborate with Call Center, Sales, Account Management, Marketing, and Health Services to enhance organizational, determining the most effective educational materials
Coordinate PBM employer group reporting and support external customer discussions, interpreting pharmacy trends and benefit design to provide clear guidance and recommendations.
Work with Risk Management to evaluate high-cost claims and determine actions for Short Term Health Plan denials.
Assist Plan Product and related departments with mask configuration and system research, exercising judgment when deciding how to partner with the PBM on benefit or system updates.
Coordinate with PBM and pharmacy vendors to gather and review materials for presentations to Quality Improvement Committee (QIC), including analyses of program performance, pharmacy policies, vendor performance, and audit requirements.
Quantify savings and outcomes for pharmacy programs, evaluating results and determining opportunities for process improvements or cost reductions.
Other duties as assigned
Minimum Qualifications
High school diploma and work-related experience.
5 or more years in a Pharmacy Benefit role, working for a Health Insurer, Pharmacy Benefit Manager, or equivalent
Knowledge of health benefits insurance carrier concepts, pharmacy benefit management operations, terminology, and relevant regulatory standards (URAC, CMS, state).
Understanding of pharmacy claims processing, formulary management, and basic utilization review workflows.
Excellent communication and strong relationship management skills with internal and external partners.
Strong analytical and problem-solving skills,
Strong attention to detail skills, and ability to manage multiple priorities.
Preferred Qualifications
Associate's degree in business, healthcare, or related field,
Remote Work Requirements
High speed cable or fiber internet.
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
Please review Remote Worker FAQs for additional information.
Benefits
Remote and hybrid work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Professional and Leadership Development Programs
Review additional benefits: (https://www.wpshealthsolutions.com/careers/)
Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the... For full info follow application link.
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.
