Director Of Health Benefits (Medical & Pharmacy)

Job Title

Director of Health Benefits (Medical & Pharmacy)

Position Overview

Director of Health Benefits (Medical & Pharmacy)

Shaw is seeking a Director of Employee Health & Welfare Benefits to lead the strategy and hands-on execution of our self-funded medical, pharmacy, and dental programs covering 27,000+ enrolled lives nationally, with an additional global footprint.  Reporting to the Director of Health & Wellness, this role serves as the primary owner of medical and PBM plan design, carrier and vendor relationships, RFP execution, and full-cycle implementation management.

This is a highly accountable player-coach role. The Director will balance thoughtful plan design and cost strategy with detailed operational ownership, including vendor onboarding, file feeds, Workday setup, invoicing oversight, and service center leadership, to ensure seamless execution and a strong associate experience.

The position will work from our Dalton, GA corporate headquarters in a hybrid way, with three days a week on site.

Responsibilities:

Strategic Leadership & Benefits Program Design

• Lead the strategy and ongoing design of Shaw's medical and pharmacy benefit programs, ensuring alignment with organizational objectives, financial sustainability, and associate well-being.

• Own medical and pharmacy plan design, including formulary strategy, specialty drug management, and clinical policy decisions.

• Serve as the enterprise subject-matter expert for medical and pharmacy plan design, contracting, and operational governance.

• In partnership with leadership, shape the long-term medical and pharmacy roadmap while ensuring day-to-day execution excellence.

• Ensure compliance with all federal, state, and regulatory requirements of medical and pharmacy benefit plans.

Analytics, Vendor Strategy & Cost Management

• Lead contract negotiations, renewals, and RFPs with medical carriers, PBMs, and third-party vendors; serve as a primary stakeholder in finalist evaluations and vendor selection.

• Establish and manage vendor governance structures, performance metrics, and accountability standards.

• Synthesize complex claims and utilization data to identify cost drivers and deliver actionable plan design recommendations.

• Partner with brokers/consultants and internal finance stakeholders to develop cost projections, contribution modeling, and financial forecasting.

• Conduct competitor benchmarking and policy analyses to ensure plan competitiveness and market alignment.

Operational Execution & Implementation Ownership

• Own the full lifecycle of medical and pharmacy implementations, including vendor onboarding, contract transition, and operational readiness.

• Oversee file feeds, system configuration (including Workday setup), invoicing oversight, eligibility integrations, and cross-functional coordination.

• Partner with HRIS, Payroll, Finance, and external vendors to ensure accurate data flows and seamless member experience.

• Provide leadership oversight to Shaw's Health & Wellness Service Center operations, ensuring service excellence and operational efficiency.

• Manage direct reports including service center leadership and clinical program oversight (e.g., VIRTA rollout and future vendor integrations).

Requirements:

• Bachelor's degree in Business, HR, Health Administration, Public Health, Pharmacy, or related field (or equivalent experience).

• 10+ years progressive experience preferably in employer benefits/health plan strategy, health plan operations, benefits consulting, PBM/health plan employer strategy, or equivalent.

• Demonstrated ownership of medical + PBM plan design for a complex employer plan (self-funded experience strongly expected).

• Proven experience leading RFPs/renewals and contract negotiations with PBMs, medical carriers, and/or major point solutions-including financial terms and performance requirements.

• Strong command of claims/benefits analytics and the ability to build ROI/financial impact cases that stand up to Finance scrutiny.

• Working knowledge of ACA, ERISA, HIPAA (and ability to partner effectively with Legal/Compliance).

• Executive presence: can influence senior stakeholders and present clearly to leadership and cross-functional teams.

• Strong project leadership: can take strategy into implementation and sustain results through governance.

• High discretion/confidentiality; limited travel (2-4 trips annually).

Preferred Experiences:

• Experience managing large self-funded plans (10,000+ covered lives preferred).

• Background in benefits consulting or employer-facing PBM/carrier strategy roles.

• Exposure to global benefits programs (Canada and other regions) strongly preferred, with future opportunity to support expanded global oversight.

• Experience integrating medical and pharmacy strategy with wellness, onsite clinics, and point solutions.

• Experience evaluating/implementing carve-outs or value-based partners (e.g., specialty/infusion, centers of excellence, advanced primary care, navigation, behavioral health).

• Deep understanding of specialty drug management and pharmacy trend drivers, and how to operationalize controls while maintaining member experience.

Competencies:

Establish Strategic Direction

Drive Entrepreneurial Success

Drive Execution

Lead Change

Build Strategic Partnerships

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Work Shift

8 Hr non-rotating shift, Hrs fall to in punch day, Observed Calendar, shift starts AM

Shaw Industries is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities.