Associate Counsel – Pharmacy Benefit Management

This is a fully remote position, open to applicants in Alabama, +22 more states.

📋 Description

• Provide legal assistance for Blue Cross NC’s Pharmacy Benefit Manager services, which include services offered to the North Carolina State Health Plan.

• Cultivate and sustain a thorough understanding of PBM contracts and their associated legal obligations.

• Evaluate PBM materials, communications, program documents, policy updates, vendor submissions, and other relevant work products.

• Counsel business partners on PBM contractual obligations regarding pharmacy administration, claims processing, formulary support, rebates, pricing, reporting, member communications, audits, and vendor performance.

• Act as legal counsel for the PBM business and the administration of the State Health Plan PBM contract.

• Provide guidance on federal and state legal and regulatory stipulations impacting pharmacy benefits and health plan administration.

• Assist in pharmacy benefit initiatives, benefit modifications, vendor integrations, member communications, reporting processes, and operational workflows.

• Offer advice on privacy, security, data governance, confidentiality, and information-sharing obligations.

• Support responses to audits, investigations, administrative inquiries, regulatory requests, compliance reviews, and information requests.

• Help with public records requests and confidentiality assessments.

• Keep track of legal, regulatory, legislative, and market changes, and relay their implications to stakeholders.

• Provide legal support for member complaints, appeals, grievances, claims administration issues, pharmacy network challenges, benefit interpretation, and vendor disputes.

• Create and deliver training on legal, regulatory, contractual, and compliance subjects.

• Assist in developing legal issues and carry out other assigned duties.

⛳️ Requirements

• Must be a graduate of an accredited law school.

• At least 3 years of experience in a related field.

• Must be licensed to practice law.

• Experience in supporting pharmacy benefit management, pharmacy benefits, health plan administration, self-funded health plans, government-sponsored health programs, or large employer group health plans.

• Background in advising on PBM contracts, pharmacy benefit administration, rebate arrangements, formulary issues, pharmacy networks, specialty pharmacy, claims administration, or vendor oversight.

• Knowledge of Chapter 135 of the North Carolina General Statutes, the North Carolina State Health Plan, public procurement, government contracting, and public records laws.

• Experience in assessing insurance regulatory requirements for governmental or self-funded health plan arrangements.

• Expertise in advising on federal requirements that affect health plans, pharmacy benefits, privacy, data use, transparency, claims administration, or vendor management.

• Proficiency in reviewing and interpreting complex service agreements, performance guarantees, implementation requirements, reporting obligations, financial terms, and audit provisions.

• Strong ability to identify issues and demonstrate sound judgment.

• Capability to provide timely, practical, and legally supportable feedback.

• Skill in translating complex legal and contractual requirements into clear, actionable guidance.

• Exceptional written and verbal communication skills.

• Collaborative approach to client service, vendor oversight, and relationship management.

• Intellectual curiosity, adaptability, sound judgment, and a strong desire to learn.

🏝️ Benefits

• Work-life balance, flexibility, and autonomy.

• Medical, dental, and vision coverage.

• Health and wellness programs.

• Parental leave and support.

• Assistance with adoption and surrogacy.

• Career development programs.

• Tuition reimbursement for ongoing education.

• 401k match along with an annual company contribution.

• Annual incentive bonus.

• Paid Time Off (PTO).