Pharmacy Technician, Member Services

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

📋 Description

• Monitor prescription claim denials from third-party pharmacies.

• Reach out to members and providers regarding these denials and suggest alternative options when applicable.

• Engage in discussions around prior authorization decisions with members and providers.

• Assess extenuating requests and process overrides within the CAPRx JUDI system.

• Coordinate non-formulary drug alternatives and inform members and providers accordingly.

• Contact third-party pharmacies to reprocess claims and relay information about drug alternatives and prior authorization status.

• Correct claims and prior authorization requests as necessary.

• Act as a subject matter expert on pharmacy and drug benefits.

• Manage escalated inquiries from members, providers, pharmacies, and the member services team.

• Provide after-hours support for issue resolution when required.

• Process notifications to the member services team for outreach and updates on prescription status.

• Collaborate with leadership to enhance policies and processes.

• Perform additional assigned duties, project management, and data reporting.

• Adhere to US regulatory and Quality System requirements, including 21 CFR 820.

• Participate in mandatory remote training and complete competency and retention exams.

⛳️ Requirements

• At least 5 years of experience in pharmacy or PBM operations.

• An Associate's degree (A. A.) or equivalent from a two-year college or technical school; or six months to one year of related experience and/or training; or an equivalent combination of education and experience.

• Active PTCB certification is required.

• Consistent attendance is crucial for success in this role.

• Strong computer and phone skills, with a keen attention to detail and adherence to processes and policies.

• Call Center experience is preferred but not mandatory.

• Exceptional verbal and written communication abilities.

• Strong interpersonal skills.

• Active listening skills to accurately address inquiries and requests.

• Outstanding organizational skills; retention of policy and process knowledge is essential.

• Minimum intermediate skills in Google and Microsoft Office Suite products.

• Experience with Talkdesk or other VOIP phone systems is preferred but not required.

• Familiarity with Helpscout or similar email ticketing systems is preferred but not required.

• Experience with JUDI or other prescription claims systems is preferred but not required.

• Proficiency with Slack, Gmail, and Zoom Conference is preferred but not required.

• Must have a quiet, secure, and distraction-free home work environment.

• Must have stable, password-protected internet access.

• Work location must be secure and private to ensure HIPAA compliance.

• Required to attend the full mandatory remote training program and achieve a passing grade of 90% or above on daily competency exams and retention assessments.

• Expected travel: 0%.

🏝️ Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan).

• $0 copays and $0 deductibles (upon completion of our Baseline Visit).

• Preventive and primary care included.

• Mental health support available.

• Personalized care navigation.

• Programs for chronic conditions (diabetes, weight management, hypertension).

• Support for maternity and family planning.

• Access to 24/7/365 Curative Telehealth.

• Comprehensive pharmacy benefits.

• Extensive dental and vision coverage.

• Employer-sponsored life and disability coverage with additional supplemental options.

• Flexible spending accounts.

• Generous PTO policy along with 11 paid company holidays annually.

• 401K plan available for employees.

• Up to 8–12 weeks of paid parental leave, depending on role eligibility.

• Stipend for password-protected, stable internet access.

• Office equipment provided, including a PC, monitor, keyboard, mouse, and headset.

• Minimum 2–3 week remote training program.