Pharmacy Benefit Manager Examiner II
Pharmacy Benefit Manager Examiner II
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1 Vacancy
Job Description
The work we do matters!
Hiring Agency:
Insurance Agency 22
Location:
Hiring Rate:
Job Posting:
Applications No Longer Accepted On (If no date is displayed job is posted as open until closed):
Job Description:
The PBM examiner will perform reviews of contractual provisions between Pharmacy Benefit Managers and Pharmacists as well as coordinate and work with the Legal Division to ensure compliance with the Pharmacy Benefit Manager Licensure and Regulation Act. The PBM examiner will assist the Legal Division with licensure of PBMs investigate complaints and provide referrals to Legal Division for potential action against PBMs in violation of the Act.
Look at what we have to offer!
13 paid holidays
Vacation and sick leave that begin accruing immediately
Military leave
156 (thats not a typo! statematched retirement
Tuition reimbursement
Employee assistance program
79 employer paid health insurance plans
Dental and vision insurance plans
Employerpaid $20000 life insurance policy
Public Service Loan Forgiveness Program (PSLF) through the Federal government
Wide variety and availability of career advancement as the largest and most diverse employer in the State
Opportunity to be part of meaningful work and make a difference through public service
Training and Development based on your career aspirations
Fun inviting teammates
A safe and secure environment
At the State we stand by our core values of treating others with dignity and respect acting ethically in all situations and creating an environment where our customer is our top priority. Apply to join our team today!
Job Duties
Conduct PBM audit examinations on PBM entities operating in the state in accordance with the Pharmacy Benefit Manager Licensure and Regulation Act requirements.
Examine PBM records for compliance with maximum allowable cost (MAC) price lists requirements under the Act.
Analyzing compliance pertaining to review of pharmacy audits conducted by PBMs pharmacy reimbursement dispensing fee requirements annual reports contract review internal and external appeals and claims processing.
Complete PBM examination work according to state and NAIC Market Regulation Handbook requirements.
Interpret state rules and regulations pertaining to enforcement requirements of PBMs and related examinations thereof.
Assisting with research monitoring and summarizing of new PBM state and federal industry compliance legislation and regulations.
Review PBM licensure and renewal applications in accordance with established checklists and provide feedback for enhancements to licensure process.
Assist leadership in various PBM practice development activities including strategic discussions tasks and partnerships.
Review of Contractual Provisions between PBMs and Pharmacists for compliance with the Act.
Examine PBMs audit requirements for compliance with the act.
Investigate Pharmacy complaints and refer violations to the Legal Division for possible administrative actions.
Requirements / Qualifications
Minimum Qualifications: Bachelors degree in business or related field AND one year of experience in insurance industry or insurance regulation or related field; OR Associate degree in business or related field AND three years experience in insurance industry or insurance regulation or related field; OR Five years experience working in insurance industry or insurance regulation or related field.
Preferred Qualifications: Bachelor Degree in Business Health or related field. Pharmacy Tech Certification. Prior Experience in a Pharmacy and/or Insurance Industry
Other: This position requires travel. As such the incumbent must be able to present a valid drivers license or another form of reliable transportation. Regular and reliable attendance is required.
Knowledge Skills and Abilities
Ability to obtain the Certified Insurance Examiner (CIE) Market Conduct Management (MCM) and/or other pertinent designations relevant to the PBM industry including continuing education requirements.
Prior healthcare and/or health insurance auditing experience.
Industry PBM professionals encouraged to apply (CPBS CPhT).
Exceptional legal research writing and verbal communication skills.
Strong interpersonal presentation analytical legal and examination/audit skills.
Excellent organizational skills and the ability to prioritize multiple tasks with competing priorities projects and assignments using effective time management skills.
Must be selfmotivated work well independently possess a sense of urgency and be flexible with directional changes.
Proficient in Microsoft Office (Word Excel PowerPoint and Outlook) and Adobe Acrobat PDF.
Benefits
We offer a comprehensive package of pay benefits paid time off retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.
Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position agency and employment status. For more information on benefits please visit: Opportunity Statement
The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity inclusion and belonging. We recruit hire train and promote in all job classifications and at all levels without regard to race color religion sex. age national origin disability marital status or genetics.
Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub Internal Apply app from your home landing page.
Required Experience:
Manager
Employment Type
Full-Time
