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 and surrogacy assistance   
• Career development programs and tuition reimbursement for continued education  
• 401k match including an annual company contribution   

• Learn more   

Where You’ll Work 

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. 

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter. 

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process. 

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.
 

$130,560.00 - $208,896.00

Skills

Business Contracts, Contract Evaluations, Contract Management, Contract Negotiations, Contract Operations, Contracts Analysis, Government Affairs, Law, Legal Agreements, Legal Compliance, Legal Documents Preparation, Legal Practices, Legal Representation, Legal Services, Outside Counsel Management, Regulations, Regulatory Compliance, Regulatory Filings, Statutory Interpretation

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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].