Director of Health Benefits (Medical & Pharmacy)
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Job Location:
Dalton, GA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Job Title
Director of HealthBenefits (Medical & Pharmacy)Position Overview
DirectorofHealthBenefits (Medical&Pharmacy)
Shaw is seeking a Director of Employee Health & WelfareBenefits to lead the strategy and hands-on execution of our self-funded medicalpharmacy and dentalprograms covering 27000 enrolled lives nationally with anadditionalglobal footprint. Reporting to the Director of Health & Wellness this role serves as the primary owner of medical and PBM plan design carrier and vendor relationships RFP execution and full-cycle implementation management.
This is a highly accountable player-coach role. The Director will balance thoughtful plan design and cost strategy with detailed operational ownershipincluding vendor onboarding file feeds Workday setup invoicing oversight and service center leadershipto ensure seamless execution and a strong associate experience.
The position willworkfrom our Dalton GA corporate headquartersina hybrid way withthree days a week on site.
Responsibilities:
Strategic Leadership & Benefits Program Design
Lead the strategy and ongoing design of Shaws medical and pharmacy benefit programs ensuring alignment with organizationalobjectives financial sustainability and associate well-being.
Own medical and pharmacy plan design including formulary strategy specialty drug management and clinical policy decisions.
Serve as the enterprise subject-matter expert for medical and pharmacy plan design contracting and operational governance.
In partnership with leadership shape the long-term medical and pharmacy roadmap while ensuring day-to-day execution excellence.
Ensure compliance with all federal state and regulatory requirementsofmedical and pharmacy benefit plans.
Analytics Vendor Strategy & Cost Management
Lead contract negotiations renewals and RFPs with medical carriers PBMs and third-party vendors; serve as a primary stakeholder in finalist evaluations and vendor selection.
Establish and manage vendor governance structures performance metrics and accountability standards.
Synthesize complex claims andutilizationdata toidentifycost drivers and deliver actionable plan design recommendations.
Partnerwith brokers/consultants and internal finance stakeholders to develop cost projections contribution modeling and financial forecasting.
Conduct competitor benchmarking and policy analyses toensure plancompetitiveness and market alignment.
Operational Execution & Implementation Ownership
Own the full lifecycle of medical and pharmacy implementations including vendor onboarding contract transition and operational readiness.
Oversee file feeds system configuration (including Workday setup) invoicing oversight eligibility integrations and cross-functional coordination.
Partner with HRIS Payroll Finance and external vendors to ensureaccuratedata flows and seamless member experience.
Provide leadership oversight to Shaws Health & Wellness Service Center operations ensuring service excellence and operational efficiency.
Manage direct reports including service center leadership and clinical program oversight (e.g. VIRTA rollout and future vendor integrations).
Requirements:
Bachelors degree in Business HR Health Administration Public Health Pharmacy or related field (or equivalent experience).
10 years progressive experiencepreferablyin employer benefits/health plan strategy health plan operations benefits consulting PBM/health plan employer strategy or equivalent.
Demonstrated ownership of medical PBM plan design for a complex employer plan (self-funded experience strongly expected).
Proven experience leading RFPs/renewals and contract negotiations with PBMs medical carriers and/or major point solutionsincluding financial terms and performance requirements.
Strong command of claims/benefits analytics and the ability to build ROI/financial impactcases that stand up to Finance scrutiny.
Working knowledge of ACA ERISA HIPAA (and ability to partner effectively with Legal/Compliance).
Executive presence: can influence senior stakeholders and present clearly to leadership and cross-functional teams.
Strong project leadership: can take strategy into implementation and sustain results through governance.
High discretion/confidentiality; limited travel (24 trips annually).
Preferred Experiences:
Experience managing large self-funded plans (10000 covered lives preferred).
Background in benefits consulting or employer-facing PBM/carrier strategy roles.
Exposure to global benefits programs (Canada and other regions) strongly preferred with future opportunity to support expanded global oversight.
Experience integrating medical and pharmacystrategywith wellness onsite clinics and point solutions.
Experience evaluating/implementing carve-outs or value-based partners (e.g. specialty/infusion centers of excellence advanced primary care navigation behavioral health).
Deep understanding of specialty drug management and pharmacy trend drivers and how to operationalize controls whilemaintainingmember experience.
Competencies:
Establish Strategic Direction
Drive Entrepreneurial Success
Drive Execution
Lead Change
Build Strategic Partnerships
#LI-TA1
#ShawIND
Work Shift
8 Hr non-rotating shift Hrs fall to in punch day Observed Calendar shift starts AMRequired Experience:
Director
Key Skills
About Company
We are approximately 20,000 individuals bound together by a common vision to create a better future, for our customers, for our company, for our people, and for our communities. By combining deep market knowledge with new ways of thinking, we drive innovation into our business and set ... View more
