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Client Services Specialist- Direct to Employer PBM

Job ID: 12114
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Client Services Specialist will provide daily support for our pharmacy benefit clients including implementations, quality assurance, troubleshooting claims issues, reporting/analyzing data, and more. 

Responsibilities:

Establish processes for onboarding new clients and account management activities. Support implementation and client management teams with all day-to-day client requirements. Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations.
Analyze incoming client requests and work with internal and external teams to complete required plan documentation. Support implementation of new plans, pricing, and networks, consistent with clients’ intent. Lead pre- and post-implementation quality assurance and testing to validate coding accuracy.
Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address. Handle and resolve client and member issues, escalating as needed. Research and respond to claims processing and system configuration inquiries.
Collaborate cross functionally to support general client operations, as required.


Other Information

Other information:
Education Requirements:
● Requires Bachelor's degree in relevant field
Licensure/Certification Requirements:
● No licensure or certification required
Professional Experience Requirements:
● Requires two years of broad, operational experience and leading large projects
Knowledge/Skills/and Abilities Requirements:
● Prefers:
• Pharmacy benefits and/or managed care experience
• Experience in a quality assurance
• Proficient in Microsoft Office
• Experience working with large amounts of data

● • Excellent communication skills
• Strong organizational and time management skills
• Perform effectively in cross-functional groups
• Ability to lead projects and meet critical deadlines
• Attention to detail & commitment to delivering high quality work product
• Ability to balance multiple complex projects simultaneously


Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Direct to Employer PBM 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes



This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

Equal Employment Opportunity

UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.

To verify employment eligibility, UNC Health is committed to Form I-9 and the E-Verify process. Learn further E-Verify details in English or Spanish.

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