Senior Pharmacy Underwriter

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Written by AI from the job title and company, not by BlueCross BlueShield of South Carolina, so some details may not match this job. The employer's own page has the real description.

Job Overview

The Senior Pharmacy Underwriter at BlueCross BlueShield of South Carolina will play a critical role in the assessment, evaluation, and management of pharmacy benefit plans. This position involves analyzing pharmacy claims data, conducting risk assessments, and collaborating with other departments to develop competitive underwriting strategies. Additionally, the Senior Pharmacy Underwriter will provide insights that help shape policy decisions and improve overall pharmacy benefit offerings for the organization while ensuring compliance with industry regulations.

Job Responsibilities

• Evaluate and underwrite pharmacy benefit plans by analyzing claims data and assessing risk factors.
• Develop and implement pricing strategies and models that align with business objectives.
• Collaborate with clinical and operational teams to optimize pharmacy benefit performance.
• Monitor drug trend reports and industry market changes to inform underwriting practices.
• Prepare comprehensive reports for senior management and regulatory agencies as required.
• Conduct regular audits to ensure compliance with state and federal regulations.
• Provide guidance and mentorship to junior underwriting staff.

Qualifications

• Bachelor’s degree in Pharmacy, Finance, Business Administration, or a related field; PharmD or Master's degree preferred.
• A minimum of 5 years of experience in pharmacy underwriting or a related healthcare field.
• In-depth knowledge of pharmacy benefit design and management principles.
• Strong analytical and problem-solving skills with proficiency in data analysis and interpretation.
• Excellent communication and interpersonal skills, with the ability to interact effectively with stakeholders at all levels.
• Proficiency in underwriting software and database management tools.

Technologies & Tools

The Senior Pharmacy Underwriter will utilize various technologies and tools including advanced data analytics software, claims processing systems, and underwriting management platforms. Proficiency in using Excel for data manipulation and Microsoft Office Suite for documentation and reporting is essential. Familiarity with pharmacy benefit management (PBM) software and electronic health records (EHR) may also be required to enhance operational efficiency.

Ideal Candidates

Ideal candidates for the Senior Pharmacy Underwriter position will possess a strong foundation in both pharmacy and insurance principles. They should demonstrate a proactive approach to problem-solving, with the capability to synthesize complex data into actionable insights. Strong interpersonal skills and the ability to foster collaborative relationships across departments are crucial. Candidates should also be adaptable, detail-oriented, and committed to continuous improvement in underwriting practices to effectively contribute to the goals of BlueCross BlueShield of South Carolina.