Associate Counsel – Pharmacy Benefit Management

Job Description We’re seeking an Associate Counsel to join our legal team as legal support for Blue Cross NC’s Pharmacy Benefit Manager (PBM) services, including services provided to the North Carolina State Health Plan for Teachers and State Employees. This role is well-suited for an attorney interested in working at the intersection of health care, pharmacy benefit administration, government programs, public procurement, and highly regulated health plan operations. This position requires a strong command of state and federal laws and regulations impacting pharmacy benefit administration and health plan operations. This role will partner closely with pharmacy, compliance, operations, data, finance, vendor management, and executive teams to help ensure contractual compliance, manage legal risk, and provide timely, legally supportable guidance across Blue Cross NC’s PBM operations and client relationships. The role will support matters involving the North Carolina State Health Plan as well as other PBM and pharmacy initiatives across the enterprise. What You’ll Do   Develop and maintain a strong working knowledge of PBM contracts and related legal requirements, including vendor obligations, performance guarantees, reporting requirements, implementation milestones, financial terms, audit rights, data obligations, and operational commitments.  Review PBM-related materials, communications, program documents, policy updates, vendor submissions, and other work product and provide practical, legally supportable guidance to business partners.   Advise internal business partners on the interpretation and application PBM contractual requirements, including requirements related to pharmacy benefit administration, claims processing, formulary support, rebates, pricing, reporting, member communications, audits, and vendor performance.  Serve as legal counsel supporting Blue Cross NC’s PBM business, including administration of the State Health Plan PBM contract.   Advise business partners on federal and state legal and regulatory requirements impacting pharmacy benefits and health plan administration, including privacy, data use, transparency, claims administration, and other applicable compliance obligations.  Support implementation and ongoing administration of pharmacy benefit initiatives, benefit changes, vendor integrations, member communications, reporting processes, and operational workflows, including those relating to the North Carolina State Health Plan.  Advise on privacy, security, data governance, confidentiality, and information-sharing requirements applicable to PBM services and Plan operations.  Support responses to audits, investigations, administrative inquiries, regulatory requests, contractual compliance reviews, and other information requests involving PBM services and related operations.   Assist with public records requests, confidentiality analyses, and protection of trade secret, proprietary, confidential, and competitively sensitive information.  Monitor legal, regulatory, legislative, and market developments affecting pharmacy benefit management, government health programs, and State Health Plan operations and communicate practical implications to internal stakeholders.  Provide legal support related to member complaints, appeals, grievances, claims administration issues, pharmacy network issues, benefit interpretation, and vendor disputes.  Develop and deliver training to business partners on legal, regulatory, contractual, and compliance topics relevant to the PBM contract.  Provide support on developing legal issues and perform other duties as assigned.  What You Bring    Graduate of an accredited law school required.  3+ years of experience in related field.  Licensed to practice law Bonus Points   Experience supporting pharmacy benefit management, pharmacy benefits, health plan administration, self-funded health plans, government-sponsored health programs, or large employer group health plans.  Experience advising on PBM contracts, pharmacy benefit administration, rebate arrangements, formulary matters, pharmacy networks, specialty pharmacy, claims administration, or vendor oversight.  Familiarity with Chapter 135 of the North Carolina General Statutes, the North Carolina State Health Plan, public procurement, government contracting, and public records laws.  Experience assessing the applicability of insurance regulatory requirements to governmental or self-funded health plan arrangements.  Experience advising on federal requirements impacting health plans, pharmacy benefits, privacy, data use, transparency, claims administration, or vendor management.  Experience reviewing and interpreting complex service agreements, performance guarantees, implementation requirements, reporting obligations, financial terms, and audit provisions.  Strong issue-spotting ability and demonstrated judgment in identifying, escalating, and helping resolve legal, regulatory, contractual, and operational risks.  Ability to provide timely, practical, legally supportable feedback in a fast-moving client-service environment.  Ability to translate complex legal and contractual requirements into clear, actionable guidance for business partners and Plan stakeholders.  Excellent written and oral communication skills, including experience supporting senior leadership, operational teams, external stakeholders, and counsel.  Collaborative approach to client service, vendor oversight, and relationship management.  Intellectual curiosity, adaptability, sound judgment, and a strong learning mindset.  What You’ll Get The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work    Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption