Pharmacy Benefit Manager Examiner II at State of Nebraska in Lincoln, Nebraska

Job Description:

The work we do matters!




Hiring Agency:

Insurance - Agency 22



Location:

Lincoln, NE



Hiring Rate:

$23.278



Job Posting:

JR2025-00012733 Pharmacy Benefit Manager Examiner II (Open)



Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):



Job Description:

The Pharmacy Benefit Manager (PBM) Examiner in the Market Conduct Division will act as a PBM Specialist and/or Examiner in Charge on compliance audits of PBMs operating in the state, using state rules and regulations, established procedures, industry standards and best practices to complete the examinations.


The PBM examiner will perform reviews of contractual provisions between Pharmacy Benefit Managers and Pharmacists as well as coordinate and work with the Legal Division to ensure compliance with the Pharmacy Benefit Manager Licensure and Regulation Act. The PBM examiner will assist the Legal Division with licensure of PBMs, investigate complaints and provide referrals to Legal Division for potential action against PBMs in violation of the Act.


Look at what we have to offer!


• 13 paid holidays
• Vacation and sick leave that begin accruing immediately
• Military leave
• 156% (that's not a typo!) state-matched retirement
• Tuition reimbursement
• Employee assistance program
• 79% employer paid health insurance plans
• Dental and vision insurance plans
• Employer-paid $20,000 life insurance policy
• Public Service Loan Forgiveness Program (PSLF) through the Federal government
• Wide variety and availability of career advancement as the largest and most diverse employer in the State
• Opportunity to be part of meaningful work and make a difference through public service
• Training and Development based on your career aspirations
• Fun, inviting teammates
• A safe and secure environment


At the State, we stand by our core values of treating others with dignity and respect, acting ethically in all situations, and creating an environment where our customer is our top priority. Apply to join our team today!



Job Duties



•Conduct PBM audit examinations on PBM entities operating in the state in accordance with the Pharmacy Benefit Manager Licensure and Regulation Act requirements.
•Examine PBM records for compliance with maximum allowable cost (MAC) price lists' requirements under the Act.
•Analyzing compliance pertaining to review of pharmacy audits conducted by PBMs, pharmacy reimbursement, dispensing fee requirements, annual reports, contract review, internal and external appeals, and claims processing.
•Complete PBM examination work according to state and NAIC Market Regulation Handbook requirements.
•Interpret state rules and regulations pertaining to enforcement requirements of PBMs and related examinations thereof.
•Assisting with research, monitoring and summarizing of new PBM state and federal industry compliance legislation and regulations.
•Review PBM licensure and renewal applications in accordance with established checklists and provide feedback for enhancements to licensure process.
•Assist leadership in various PBM practice development activities, including strategic discussions, tasks, and partnerships.
•Review of Contractual Provisions between PBMs and Pharmacists for compliance with the Act.
•Examine PBMs audit requirements for compliance with the act.
•Investigate Pharmacy complaints and refer violations to the Legal Division for possible administrative actions.



Requirements / Qualifications




Minimum Qualifications: Bachelor's degree in business or related field AND one year of experience in insurance industry or insurance regulation or related field; OR Associate degree in business or related field AND three years' experience in insurance industry or insurance regulation or related field; OR Five years' experience working in insurance industry or insurance regulation or related field.



Preferred Qualifications: Bachelor Degree in Business, Health or related field. Pharmacy Tech Certification. Prior Experience in a Pharmacy and/or Insurance Industry



Other: This position requires travel. As such, the incumbent must be able to present a valid driver's license or another form of reliable transportation. Regular and reliable attendance is required.



Knowledge, Skills and Abilities



•Ability to obtain the Certified Insurance Examiner (CIE), Market Conduct Management (MCM), and/or other pertinent designations relevant to the PBM industry, including continuing education requirements.
•Prior healthcare and/or health insurance auditing experience.
•Industry PBM professionals encouraged to apply (CPBS, CPhT).
•Exceptional legal research, writing, and verbal communication skills.
• Strong interpersonal, presentation, analytical, legal, and examination/audit skills.
•Excellent organizational skills and the ability to prioritize multiple tasks with competing priorities, projects and assignments using effective time management skills.
•Must be self-motivated, work well independently, possess a sense of urgency, and be flexible with directional changes.
•Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.






Benefits



We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.


Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits



Equal Opportunity Statement



The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.



Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page.