PBM Implementation Specialist

PURPOSE: The Implementation Specialist is responsible for leading and managing the implementation of new client healthcare plans based on client benefits and regulatory specifications. The Implementation Specialist will also help facilitate enterprise-wide projects, program renewals, analysis, and continuous process improvement initiatives. The Implementation Specialist position may also be called upon to implement new regulatory changes that impact our business.

RESPONSIBILITIES:

• Lead new employer, Union, and TPA implementation processes, including driving client, consultant/broker, and data partner meetings to gather and document requirements for internal and external teams.
• Manage downstream entities, new group setup, and changes to meet expected deadlines and client expectations for multiple products, including Medicare and Commercial.
• Provide clear direction and oversight to internal and external stakeholders through Implementation and projects despite potentially challenging or complex requirements.
• Gather client benefit setup terms and effectively communicate to applicable stakeholders for new group setup.
• Ensure operational and system readiness for client launch through collaboration and consultation with applicable stakeholders.
• Identify project risks and mitigation strategies, ensuring communication with the appropriate stakeholders.
• Monitor go-live claim activity to identify potential issues and facilitate response plans to implement concise solutions.
• Help maintain benefit rework occurrences below 5% (as measured by both client event and situational event).
• Demonstrate flexibility in adjusting requirements to minimize risk or based on client requirements.
• Log all new/change requests to manage deliverable dates.
• Manage all signoffs by filing all documents to evidence the requirements and signoffs.
• Manage Implementation for accuracy and timeliness: Document and maintain process that ensures timely, authorized updates.
• Provide documents for review by all key stakeholders.
• Maintain Client signoff document.
• Define and maintain implementation timeline to provide Sales and Account Management with expected timeframes for common scenarios.

Education/Experience: 3-5 years of experience in a similar role or project management; Bachelor’s degree or combination of education and offsetting experience. Client-facing experience a plus.

Skills & Qualifications:

• Broad understanding of health benefits plan setups (deductibles, copays, drug coverage, accumulators, eligibility).
• Demonstrated Project Management and/or business analyst knowledge and applied experience, preferably in the healthcare industry.
• Strong interpersonal communication skills, including team leadership, conflict resolution, and meeting leadership/facilitation with various internal and external leaders.
• Experience with project management software and data reporting tools a strong plus.
• Experience or knowledge of pharmacy benefit manager and Medicare Part D a strong plus.
• Must be a self-starter and can solve issues independently and collaboratively.
• Goal-oriented. Significant ingenuity and flexibility are expected.
• Demonstrates initiative to learn more and take on challenges.
• Strong written and verbal communication skills required.
• Must be able to motivate people to accomplish goals with allotted resources.
• Excellent leadership, organization, and prioritization skills.
• Ability to effectively multi-task, independently prioritize work, and meet deadlines.
• Strong attention to detail and accuracy.
• Excellent teamwork abilities, flexibility, diligence, and organization skills.