Pharmacy Testing Analyst Job at Blue Cross Blue Shield of Massachusetts
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Pharmacy Testing Specialist will be responsible for ensuring the Pharmacy Services is meeting all testing requirements related to PBM and pharmacy vendor program changes (including pricing, benefit, specialty, network). The Pharmacy Testing Specialist focus includes both Commercial and Medicare PBM testing oversight, creating and executing test cases in PBM system, risk assessment, preparing documentation for submission, maintaining SharePoint folders with test cases, defects and results, as well as other audit/testing work.
Pharmacy Testing Specialist will be responsible for ensuring the Pharmacy Services is meeting all testing requirements related to PBM and pharmacy vendor program changes (including pricing, benefit, specialty, network). The Pharmacy Testing Specialist focus includes both Commercial and Medicare PBM testing oversight, creating and executing test cases in PBM system, risk assessment, preparing documentation for submission, maintaining SharePoint folders with test cases, defects and results, as well as other audit/testing work.
Key Responsibilities:
Understands flow of Rx data within the PBM and BCBSMA
Understands Rx business processes, drivers, and goals
Develops and maintains productive relationship with PBM
Develops and maintains productive relationships with BCBSMA operations and business teams
Utilizes deep knowledge of PBM processes and organization to drive delivery
Contributes business acumen and knowledge to success of business partners and enterprise
Monitor, audit, track and summarize key findings to various levels in the organization
Creates test members and cases within the PBM system
Executes test cases within PBM system
Support P&P development to ensure intent is aligned with audit requirements
Monitor PBM performance guarantees related to defect resolution and testing environment availability
Create reports of testing results, defects, track, recommend and follow up on defects with PBM
Represents department on cross functional workgroups and projects as needed
Other responsibilities as assigned
Qualifications (Knowledge, skills and abilities):
Working knowledge of Pharmacy utilization
Strong planning, organization and time management including the ability to meet tight deadlines, problem solve, and manage multiple competing priorities
Decisiveness with strategic focus as well as an operational, implementation and detail oriented
Ability to communicate (oral and written) difficult and complex subject matter to different levels of the organization
Strong data analysis and presentation skills
Strong computer skills: Microsoft Office experience, PBM systems
Experience and Education:
Bachelor’s degree required or relevant work experience
3-5 years of e xperience with pharmacy products and benefits
Experience with pharmacy benefit managers
Experience with auditing, completing, and monitoring corrective action plans is preferred
This position is eligible for the following personas: eWorker, Mobile, Resident.
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Please Note :
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
Pharmacy Testing Specialist will be responsible for ensuring the Pharmacy Services is meeting all testing requirements related to PBM and pharmacy vendor program changes (including pricing, benefit, specialty, network). The Pharmacy Testing Specialist focus includes both Commercial and Medicare PBM testing oversight, creating and executing test cases in PBM system, risk assessment, preparing documentation for submission, maintaining SharePoint folders with test cases, defects and results, as well as other audit/testing work.
Pharmacy Testing Specialist will be responsible for ensuring the Pharmacy Services is meeting all testing requirements related to PBM and pharmacy vendor program changes (including pricing, benefit, specialty, network). The Pharmacy Testing Specialist focus includes both Commercial and Medicare PBM testing oversight, creating and executing test cases in PBM system, risk assessment, preparing documentation for submission, maintaining SharePoint folders with test cases, defects and results, as well as other audit/testing work.
Key Responsibilities:
Understands flow of Rx data within the PBM and BCBSMA
Understands Rx business processes, drivers, and goals
Develops and maintains productive relationship with PBM
Develops and maintains productive relationships with BCBSMA operations and business teams
Utilizes deep knowledge of PBM processes and organization to drive delivery
Contributes business acumen and knowledge to success of business partners and enterprise
Monitor, audit, track and summarize key findings to various levels in the organization
Creates test members and cases within the PBM system
Executes test cases within PBM system
Support P&P development to ensure intent is aligned with audit requirements
Monitor PBM performance guarantees related to defect resolution and testing environment availability
Create reports of testing results, defects, track, recommend and follow up on defects with PBM
Represents department on cross functional workgroups and projects as needed
Other responsibilities as assigned
Qualifications (Knowledge, skills and abilities):
Working knowledge of Pharmacy utilization
Strong planning, organization and time management including the ability to meet tight deadlines, problem solve, and manage multiple competing priorities
Decisiveness with strategic focus as well as an operational, implementation and detail oriented
Ability to communicate (oral and written) difficult and complex subject matter to different levels of the organization
Strong data analysis and presentation skills
Strong computer skills: Microsoft Office experience, PBM systems
Experience and Education:
Bachelor’s degree required or relevant work experience
3-5 years of e xperience with pharmacy products and benefits
Experience with pharmacy benefit managers
Experience with auditing, completing, and monitoring corrective action plans is preferred
This position is eligible for the following personas: eWorker, Mobile, Resident.
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Please Note :
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.