Pbm Consulting Jobs in Rhode Island (NOW HIRING)

Grow With Us! At Hilb Group, we recognize that our associates are our greatest asset. We promote a service-driven culture of high performance that encourages career and professional development. The Hilb Group is currently seeking a motivated and ambitious Strategy Consulting Senior Associate to join our team. This position will report to our agency located in either Cranston, RI, Canton, MA, Mansfield, MA, or Southborough, MA. The ideal candidate will be motivated to succeed, is well organized, able to prioritize, and able to work well with a team. This is an in-office position.

Responsibilities:

• Develop and execute comprehensive, multiyear benefit strategies for large and complex clients based on organizational goals, workforce needs, financial objectives, industry considerations, and risk tolerance.

• Own and manage the client Roadmap, establishing the annual planning calendar and coordinating all activities throughout the stewardship, pre-renewal, marketing, renewal, open enrollment, implementation, and post-renewal cycle.

• Lead client strategy discussions and provide recommendations related to funding arrangements, plan design, contribution strategy, employee engagement, vendor solutions, compliance, and cost management.

• Manage the annual renewal and marketing process, including setting strategy, preparing requests for proposals, analyzing proposals, negotiating with carriers and vendors, and presenting recommendations to clients.

• Provide strategic consulting for self-funded and complex funding arrangements, including ASO contract terms, administrative fees, network access, discounts, disruption, provider availability, and total cost of care.

• Lead provider network analyses to assess geographic access, employee disruption, network strength, utilization patterns, negotiated discounts, and the potential financial and member impact of network changes.

• Evaluate pharmacy benefit strategies, including integrated and carved-out pharmacy arrangements, PBM contracting, rebate guarantees, formulary management, specialty pharmacy programs, utilization management, and contract terms.

• Advise clients on complex leave and disability programs, including the coordination of federal, state, local, employer-sponsored, and carrier-administered leave benefits.

• Review ancillary benefit contracts and identify provisions that may affect eligibility, coverage, claims, administration, and financial outcomes.

• Apply industry-specific knowledge to evaluate benefit program needs, contract language, workforce considerations, compliance obligations, and specialized plan requirements.

• Lead stop-loss placement and ongoing management, including evaluation of specific and aggregate deductibles, contract basis, lasers, exclusions, aggregating specific provisions, renewal terms, and carrier capabilities.

• Monitor stop-loss performance throughout the plan year, including large claimant activity, reimbursement status, pended or denied claims, disclosure requirements, and potential renewal exposure.

• Review utilization, claims, pharmacy, financial, and large claimant reporting to identify trends, emerging risks, cost drivers, and opportunities for intervention.

• Translate complex financial and clinical data into clear, actionable recommendations for clients and internal teams.

• Partner with Producers to lead client meetings, executive presentations, finalist meetings, and the onboarding of new clients.

• Serve as the primary strategic contact and escalation point for assigned clients, coordinating internal and external resources to resolve complex service, claims, contractual, and administrative issues.

• Build and maintain strong relationships with client executives, Human Resources leaders, finance teams, benefit administrators, carriers, TPAs, PBMs, stop-loss carriers, and other vendor partners.

• Partner with carriers and vendors to improve plan performance, participant outcomes, service delivery, and compliance with plan guidelines and contractual requirements.

• Provide direction on client messaging strategy and review employee benefit communications, enrollment materials, decision-support tools, and other client-facing content.

• Oversee the implementation of benefit program changes, new vendors, funding arrangements, and administrative solutions.

• Advise clients on applicable benefit compliance requirements and coordinate with internal compliance resources on matters including ACA reporting, PCORI fees, ERISA requirements, DOL audits, and other regulatory obligations.

• Maintain current knowledge of market trends, benchmarking, legislation, compliance requirements, analytics, emerging vendor solutions, and industry developments.

• Provide guidance, technical support, and training to Consultants, Account Managers, Client Care Specialists, and other client service team members.

• Mentor junior consulting staff and support their professional development, client management skills, and technical knowledge.

• Delegate responsibilities appropriately and provide clear expectations, oversight, and feedback to ensure timely and accurate completion of client deliverables.

• Document meeting outcomes, recommendations, decisions, and required follow-up after renewal and other significant client meetings.

• Participate in market meetings, client functions, industry seminars, and professional development programs as needed.

• Perform additional duties and strategic projects as assigned.

• Travel as needed, including occasional overnight travel.

• Conduct meetings outside standard business hours when reasonably required by client needs.

Qualifications:

• Education: Bachelor's degree in business, finance, healthcare administration, human resources, or a related field preferred.

• Certification: L&H license

• Seven or more years of employee benefits experience within a brokerage, consulting, carrier, TPA, PBM, or related environment.

• Demonstrated experience managing large, complex, and preferably self-funded clients.

• Strong knowledge of self-funded medical plans, ASO arrangements, provider networks, pharmacy benefits, ancillary benefits, stop-loss coverage, and complex leave programs.

• Experience leading benefit renewals, carrier and vendor marketing, financial analysis, contract review, negotiation, and implementation.

• Ability to interpret complex carrier, ASO, PBM, stop-loss, and ancillary contract language and explain its financial and operational implications to clients.

• Strong understanding of the unique benefit needs and contractual considerations associated with specialized industries and diverse employee populations.

• Proven ability to develop strategic recommendations using claims, utilization, financial, pharmacy, network, and benchmarking data.

• Strong project management skills, including the ability to establish timelines, coordinate multiple stakeholders, manage competing priorities, and execute deliverables accurately and on schedule.

• Proven ability to manage multiple complex client relationships in a fast-paced environment.

• Strong leadership and mentoring skills with the ability to guide and develop junior team members.

• Excellent written, verbal, presentation, negotiation, and interpersonal communication skills.

• Strong judgment, resourcefulness, attention to detail, and problem-solving ability.

• Ability to work independently, make sound decisions, and perform effectively under pressure.

• Ability to collaborate effectively as both a team member and a team leader.

• Advanced proficiency in Microsoft Office applications, particularly Excel, PowerPoint, Outlook, and Teams.

Benefits:

• Compensation: $200,000-$220,000/yr.

• Company Paid Life Insurance, Long-Term and Short-Term Disability.

• Medical, Dental, Vision and FSA/HSA plans.

• 401(k) with company match.

• Additional voluntary benefits including Critical Illness, Accident Insurance, Hospital Indemnity and Supplemental Life Insurance, Legal and Identity Protection, and Pet benefits.

• Generous PTO.

• An awesome team of professionals!

The Hilb Group is an equal opportunity employer, and we actively support and comply with all applicable federal, state, and local laws prohibiting all forms of discrimination in employment. Additionally, we have a zero-tolerance policy for all forms of harassment in violation of federal, state, and local laws.