Pharmacy Technician – Health Plan

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

📋 Description

• Evaluate daily point-of-service (POS) pharmacy claims, address actionable items, track progress, and deliver reporting.

• Act as a liaison with the Enrollment Department to ensure proper processing of member eligibility.

• Collaborate with the Pharmacy Benefit Manager (PBM) management team to achieve optimal performance levels.

• Understand formulary requirements such as prior authorization (PA), Step Therapy (ST), Quantity Limit (QL), and be familiar with NCPDP reject codes.

• Communicate effectively with pharmacies, nursing facilities, and healthcare providers.

• Coordinate clinical reporting efforts.

• Follow up on and resolve outstanding items promptly.

• Participate in special projects and business initiatives as assigned.

• Carry out additional responsibilities as needed.

⛳️ Requirements

• High school diploma or equivalent qualification.

• A minimum of 2 years of experience as a Pharmacy Technician, in long-term care, or within a health plan environment.

• Background in planning and implementation.

• Pharmacy Technician certification is preferred.

• Proficient in Microsoft Suite applications.

• Capability to navigate multiple systems efficiently.

• Strong analytical abilities.

• Excellent communication and presentation skills.

• Compliance with Centers for Medicare and Medicaid Services (CMS) regulations and requirements.

• Successful completion of mandatory training.

• Must effectively perform each essential function satisfactorily, with or without reasonable accommodation.

🏝️ Benefits

• Affordable options for Medical/Dental/Vision insurance.

• Generous paid time-off program and paid holidays for full-time employees.

• 24/7/365 access to doctors through TeleDoc.

• Optional short- and long-term disability plans.

• Employee Assistance Plan (EAP).

• 401K retirement plans with company matching.

• Employee Referral Bonus Program.

• Reasonable accommodations for qualified individuals with disabilities.