Pharmacy Services Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Aid in the creation and oversight of pharmacy benefit administration for existing and new plan designs or products.

• Organize daily functions related to pharmacy benefit management operations or nonclinical reviews and call center support.

• Assist staff and coordinate tasks for the research, development, implementation, and assessment of programs, projects, and initiatives.

• Act as a resource and subject matter expert concerning pharmacy requirements, impacts, and projects.

• Address issues and escalate them to management when necessary.

• Support management with clinical and contractual matters.

• Oversee the review, implementation, and quality assurance of benefit plan administration in collaboration with internal stakeholders and the PBM account team.

• Resolve advanced customer service inquiries and complaints, which includes researching and authorizing or adjusting pharmacy claims.

• Coordinate Pharmacy Coverage Determinations with clinical staff and external partners.

• Manage pharmacy claim reconsiderations and appeals in conjunction with the Appeals department and external partners.

• Respond to and coordinate the review and approval of RFPs, government program applications, and similar requests.

⛳️ Requirements

• High School Diploma or GED.

• Over 3 years of experience in relevant fields.

• Strong communication and interpersonal skills.

• Exceptional time management and organizational skills.

• Proficiency in Microsoft Office Suite.

• Availability to work weekends and holidays as required to meet business and operational needs.

🏝️ Benefits

• Work-life balance, flexibility, and autonomy.

• Medical, dental, and vision coverage.

• Health and wellness programs.

• Parental leave and support.

• Adoption and surrogacy assistance.

• Career development programs.

• Tuition reimbursement for continued education.

• 401k match along with an annual company contribution.

• Annual Incentive Bonus.

• Paid Time Off (PTO).