Job Details

Summary of Job

Manage and nurture client relationships within EmblemHealth's employer group clients to ensure they have the information, products, and support needed from the health plan. Responsible for building and expanding existing pharmacy service contract accounts. Work with internal departments (sales, claims, contracting, marketing) to serve accounts effectively and ensure compliance. Analyze account and service provision data, developing process improvements as needed. Collaborate with sales and account management on new prospects and current account renewals as relates to the pharmacy benefit. Support sales, marketing, account management and bid support by serving as the main point of contact for non-clinical client inquiries related to pharmacy benefit setup, claims issues, eligibility, and billing.

Responsibilities

• Identify opportunities for upselling and cross-selling, implementing sales strategies to retain and grow accounts, and tracking sales performance.
• Provide oversight to account management teams and internal partners as relates to pharmacy benefits, focusing on member and client satisfaction, trend management, and client retention.
• Build and maintain strong relationships with key company decision-makers, understanding healthcare strategies, and ensuring client and member satisfaction.
• Work with internal partners to address ongoing service needs, and support Account Management with the Pharmacy Benefit set up and onboarding activities for new clients.
• Develop and deliver quarterly business reviews for key clients.
• Partner with product teams on annual revisions to each product line ensuring lowest cost, highest value plans in the market.
• Direct Pharmacy Benefit Manager (PBM) in plan design activities.
• Respond to and resolve client issue escalations and resolution, working with internal partners to ensure timely responses.
• Track and resolve member issue trends, developing process improvements within the team.
• Ensure client contractual requirements are met and participate in contract renewals.
• Interpret and analyze pharmacy claims data to identify trends and provide actionable insights.
• Monitor assigned client claims and trends to proactively identify area of potential issue. Work with internal teams to develop mitigation strategies for identified issues.
• Perform other related tasks as directed, assigned, or required.

• Bachelor's degree in business or related field
• 5 - 8+ years of relevant professional work experience in account management, customer service, or healthcare (Required)
• 6+ years of experience in pharmacy benefits management, healthcare, or managed care (Required)
• Prior account management experience (Preferred)
• Proficiency in analyzing large datasets and interpreting pharmacy claims data (Required)
• Strong analytical and problem-solving skills, with the ability to analyze data, identify trends, and develop data-driven solutions (Required)
• Excellent communication and interpersonal skills with the ability to effectively communicate with diverse audiences, including technical and non-technical stakeholders (Required)
• Ability to work effectively in a fast-paced, collaborative, cross-functional team / matrixed environment (Required)
• Strong proficiency in project management methodologies (Required)