Pharmacy Operations Specialist
- Hiring from
- United States
- Work type
- Hybrid
- Posted
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- Operational Execution
- Execute pharmacy operational processes and activities within an assigned line of business.
- Support implementation of pharmacy benefit, communication, and operational changes.
- Perform operational tasks accurately and within established timelines.
- Maintain adherence to departmental procedures, controls, and service standards.
- Benefit Administration Support
- Working knowledge and understanding of HMSA's drug benefit and different lines of business
- Interpreting requirements and impact analyses and benefit testing to validate accuracy and intended results
- Analyzes and assess business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency
- Support benefit configuration validation, testing activities, and implementation readiness efforts.
- Review operational outputs to identify discrepancies, issues, and/or data concerns.
- Assist with documentation and maintenance of operational procedures and process materials.
- Support activities associated with pharmacy benefit administration and operational execution.
- Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review
- Issue Identification & Resolution Support
- Identify operational issues, discrepancies, or process breakdowns during routine activities.
- Identifying and assessing operational issues; determining basis for concern
- Applying judgement to address issues within established scope and determine when escalation or guidance is needed
- Escalate issues requiring analyst, pharmacist, and/or leadership review.
- Assist with gathering information and documentation needed to support issue investigation and resolution.
- Participate in implementation and remediation activities as directed.
- Member Experience & Communication Support
- Support operational activities impacting members, pharmacies, and/or internal stakeholders.
- Assist with execution and quality review of pharmacy-related communications.
- Help ensure operational processes support a positive and consistent member experience.
- Monitor assigned activities for potential member impact and escalate concerns appropriately.
- Continuous Improvement & Team Support
- Identify opportunities to streamline operational workflows and improve efficiency.
- Participate in process improvement efforts and operational readiness activities.
- Support cross-training initiatives and maintain knowledge of multiple operational processes.
- Contribute to a collaborative and service-oriented team environment.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Bachelor's degree and two years of related work experience or an equivalent combination of education and related work experience.
- Strong organization and time management skills to work on multiple tasks and/or projects simultaneously and meet deadlines and implementation timeframes.
- Proficiency in issues identification, resolution, and program operations
- Basic working knowledge of Microsoft Office applications, including Word, Excel, Outlook, PowerPoint.
