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Pharmacy Specialist I
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Job Description
- Req#: 2019-9824
Employer Industry: Healthcare Insurance
Why consider this job opportunity:
- Salary up to $58,800
- Comprehensive health benefits (Medical/Dental/Vision)
- Generous PTO and paid volunteer time off
- Incentive plans and retirement plans available
- Opportunities for professional development and tuition reimbursement
- Supportive and innovative work environment
What to Expect (Job Responsibilities):
- Handle telephonic interactions with members, physicians, pharmacies, and internal stakeholders regarding pharmacy eligibility and claim issues
- Engage with healthcare professionals to facilitate formulary compliance and optimize generic dispensing
- Capture and evaluate clinical information for prior authorization requests
- Process complaints, appeals, grievances, and compliance-related issues
- Identify potential instances of fraud, waste, and abuse through member and provider interactions
What is Required (Qualifications):
- High School Diploma or GED required
- Minimum of two (2) years experience as a pharmacy technician
- Experience in customer service and service quality initiatives
- National Pharmacy Technician Certification (PTCB or ExCPT) required
- Knowledge of third-party prescription program claim adjudication and managed care principles
How to Stand Out (Preferred Qualifications):
- Minimum of two (2) years experience in third-party prescription program claim adjudication preferred
- Experience in a retail pharmacy or relevant pharmacy experience in managed care or a PBM organization
#HealthcareInsurance #PharmacyTechnician #CareerOpportunity #CompetitivePay #ProfessionalDevelopment
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