Description
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Serves as the pharmacy benefit pricing expert for self-insured business. Leads the development of pricing strategies. Collaborates with various internal areas to plan, direct, and analyze pharmacy opportunities, analyze existing pricing strategies, and identify emerging pricing trends, legislative changes and industry changes that could impact future strategies. Establishes relationships with key accounts and brokers and engages with members of the Sales team in presenting pharmacy benefits to accounts and brokers.
Responsibilities
- Leads the development of pharmacy pricing strategies for new business and existing clients, interacting with medical underwriting leaders to generate a competitive, holistic offer. Develops forecasted impact of pricing strategies. Helps analyze pharmacy rebate strategy to identify opportunities and works with leaders to implement enhancements to model.
- Oversees the Pharmacy response to Request For Proposals (RFP) for potential and existing clients for questions pertaining to pricing.
- Establishes and maintains relationships with key accounts and works closely with brokers and consultants in relation to the Company's Pharmacy and specialty products. Partners with Pharmacy and Marketing leaders to communicate the effectiveness of the Company's cost reducing Pharmacy programs.
- Utilizes industry relationships, innovative solutions and constructive thinking to recognize product and market trends/directions within the industry to keep the Company on the leading edge of new products or markets and maintain overall competitiveness.
- Supports Sales team members by providing strategic account direction and leading the development of analyses that demonstrates the Company's value proposition.
- Provides strategic input into the RFP process for PBM partners as well as periodic market checks and audits of our PBM Partner. Collaborates with PBM partners health plan growth team.
- Oversees the development of group contracts that accurately represent agreed upon financial terms with clients.
- Performs other duties as assigned.
Qualifications - External
Qualifications
- Bachelor's degree in business or healthcare administration, pharmacy, or a relevant field.
- Master's degree preferred.
- Equivalent education and experience directly related to the role may substitute for a degree.
- 10 years progressive health insurance industry experience which includes pharmacy product pricing and sales/client facing experience. #LI-JT1 #LI-Remote.
Professional Certification(s):
- Doctor of Pharmacy (Pharm D) a plus.
Technical Skills and Knowledge:
- Ability to apply structured analysis and deep health insurance industry knowledge to identify strategic business opportunities.
- In-depth knowledge of the sales/marketing process from lead generation to relationship management.
- Comprehensive knowledge of pharmacy pricing/rebate strategies.
- Knowledge of Request for Proposal (RFP) processes and health plan group contracts.
- Excellent verbal, written and interpersonal communications skills.
- Ability to make presentations to various audiences.
- Strong budget development and management skills.
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