Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!
Your Role
The group underwriting team is responsible for evaluating insurance risk and pricing premium rates, self-funded fees and financial guarantees for existing and potential group customers. The group underwriting team supports and collaborates with group sales and account management teams to achieve growth, customer retention and revenue goals. The Pharmacy Consulting Underwriter will report to the Senior Manager of Premier Accounts Underwriting. In this role you will work with underwriting, account management and sales to lead pharmacy performance guarantee pricing, strategy and monitoring for large group customers. You will also work closely with finance and underwriting team members to explain rebate and pharmacy network trend and support pricing.
Your Work
In this role, you will:
In partnership with the sales team, develop proposed pharmacy guarantee position and benefit offering strategies while balancing growth and profitability objectives
Lead client financial performance guarantee design, monitoring and reconciliation in partnership with the Rx Accounts and Sales team
Provide consultative support to underwriting and sales teams on pharmacy pricing and guarantee strategy and scenarios, perform analytic modeling to evaluate impact and provide recommendations to achieve profitability and membership growth objectives
Support end to end implementation of pricing strategies and tracking of the pharmacy revenue and guarantees vs plan targets
Work with Enterprise Analytics to develop and maintain client-specific reports to support guarantee monitoring, reconciliation and adjustment
Review and interpret pharmacy rebates and network reports to understand variance drivers and identify corrective actions as needed
Support accounts and sales activities for account renewal, consultative review of pharmacy trends, and RFP submissions as needed.
Provide advice on pharmacy financial pricing principles and techniques to other departments and functions including senior management
Integrate competitor's rating, pricing practices, provider's networks in new business and renewal pricing analytics
Perform complex modeling including utilization data, COHC, shared risk projections on new business prospects to optimize competitive offers
Analyze customer specific financial condition, employee demographics and past claim experience to determine degree of risk, benefits and rates for large or complex employers
Your Knowledge and Experience
Requires a bachelor's degree in a related field such as finance, mathematics, or accounting and/or equivalent combination of education and experience
Requires at least 7 years of prior relevant experience on pharmacy pricing strategies and revenue management with health plan or PBM
Requires knowledge of key pharmacy performance metrics and drivers and PBM levers
Requires strong analytical, modeling, data interpretation, and problem-solving skills to formulate actionable recommendations to support business needs
Requires effective communication and building/maintaining strong relationships with cross-functional teams
Requires excellent verbal and written skills with ability to convey and understand complex ideas and influence decision making
Requires proficiency in MS Office, particularly MS Word, PowerPoint, Excel, and other analytical software
Requires ability to work independently with minimum direction or supervision
Additional Information
About Company: o About Blue Shield of California: For more than 80 years, Blue Shield has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 7,500 employees, more than $21 billion in annual revenue and 4.5 million members. The company has contributed more than $500 million to the Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield is headquartered in Oakland, California with 21 additional locations including Sacramento, Los Angeles, and San Diego. o Our Benefits: At Blue Shield you can expect a comprehensive benefits program that offers choice and flexibility for our diverse workforce. These programs and resources include: Medical, Dental, and Vision plan benefits, 401(k) with employer match, paid time off (PTO), earned sabbatical time, paid nonprofit volunteer time, flexible work program, free online education, tuition reimbursement, a wellness reimbursement program, 12 weeks paid parental leave, and more.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.
EEO Footer: o EEO Footer: All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, state and local laws. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. o Accommodations: Blue Shield is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, services, programs and activities. To request a reasonable accommodation prior to your interview, please contact RehabWest, Inc at (760)759-7500.
