- Lead employee benefits diagnostic/planning studies, especially in pharmacy
- Provide subject matter expertise on the pharmacy landscape, including emerging trends and cost drivers
- Work directly with medical and PBM vendors to analyze the program offering and cost management solutions
- Own the process of preparing benefits plan design and pricing studies
- Implement competitive vendor search and selection initiatives
- Review of health plan renewals including assisting in rate negotiation, and analyzing financial terms for both medical and pharmacy
- Prepare financial projections and rate development
- Review health plan performance, including reviewing policy year settlements and premium rate/administrative fee renewals
- Prepare client presentations and reports
- Conduct other general health & welfare consulting activities, as required
- In addition to serving plan sponsors, other project work can include working with payers and providers in such projects as provider network development, operational claim reviews, etc.
- Bachelor’s degree in business administration, human resources, or another related field
- 8+ years’ experience in employer health plan consulting
- 1+ years experience reviewing health plan performance
- 1+ years experience preparing financial/budget projections
- Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
- Ability to travel 25%, on average, based on the work you do and the clients/sectors you serve
- Prior professional services or federal consulting experience
- 14+ years of health plan/insurance/pharmaceutical company and/or consulting experience
- Technical background in underwriting and other areas of health care finance
- Strong understanding of health care plan design and alternative delivery systems, including consumer directed health plans with HRAs and HSAs
- Knowledge (plan design and pricing) of other health & welfare benefit plans (e.g., life, disability, dental, etc.)
- Technical background in underwriting and other areas of health care finance
- CEBS Designation or Actuarial credentials.
- In-depth experience with healthcare and pharmacy benefit management, including:
- Experience performing vendor selection reviews for Self-insured Health plans administrators and PBMs
- Experience performing hospital / physician network discount and network disruption analyses
- Experience with evaluating the pricing arrangements for PBMs contracts, including evaluation of disruption related to formulary changes
- Experience reviewing and negotiating pharmacy contracts (pricing and business terms) with PBMS
- Experience performing analytical analysis of medical & pharmacy claims, including understanding financial impact of network changes, design changes and formulary changes
- Understanding of healthcare landscape, including up and coming trends in medical and pharmacy
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