Commercial Drug Analyst

1 month ago


Honolulu, United States HMSA Full time
  1. Support the pharmacy strategy from a Commercial drug benefit design and delivery perspective.

    • Maintain a deep understanding of Commercial drug benefits.
    • Work with internal HMSA staff to ensure HMSA Commercial drug plans are competitive and compliant.
    • Collaborate with other departments including MPD, Fed87 and CPO to assess new contractual and plan requirements and determine implementation needs for compliance.
    • Review and assessment of utilization and drug spend to identity opportunities.
  2. Benefit Design and Delivery
    • Work with internal HMSA staff to understand the intent of the update/change requested. Work with the Pharmacy Benefit Manager (PBM) to implement the change.
    • Analyzes business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency.
    • Implement, test, and evaluate changes made within the PBM.
    • Defines acceptance testing criteria and ensure that the criteria are met before system changes are implemented.
    • Maintain PBM system functionality to ensure operational efficiency.
    • Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review.
    • Ensure HMSA meets performance standards state by employer groups, Blue Cross Blue Shield Association, or government regulations, in addition to internal policies, procedures, workflows or business requirements
  3. AMS Support
    • Triage, track and respond to inquiries to ensure servicing needs are properly identified and addressed.

      • Identify areas for improvement.
    • Support AMS with employer group reporting needs and asks.
    • Provide RFP Support.
      • Work with PM staff to address and respond to RFP questions


  4. Project Coordination & Implementation
    • Manage projects related to implementing clinical initiatives and/or pharmacy benefit operations and improvements.
    • Review and edit requirements, specifications, business processes and recommendations related to proposed solution.
    • Provide quality, objective, and professional analysis of business needs and PBM capabilities/limitations.
    • Conducts research, evaluation of measures and value assessments of initiatives and/or programs.
    • Coordinates and facilitates planning, tracking, and installation of business requirements.
    • Assess compliance with Federal and State regulations, internal policies, procedures, and workflows
  5. Manage inquiries coming to Pharmacy Management
    • Triage, track and respond drug plan inquiries to ensure member servicing needs are properly identified and addressed.
    • Coordinates problem solving associated with inquiries.
    • Performs QI efforts to identify gaps and opportunities for improvement.
  6. Other Duties and Functions
    • Performs all other miscellaneous responsibilities and duties as assigned or directed.




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