Pharmacy Services Specialist

Immediate need for a talented Pharmacy Services Specialist. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-32228

Pay Range: $21/hr - $23/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Coordinate daily activities related to pharmacy benefit management operations.
• Support staff in the research, development, implementation, and evaluation of programs and initiatives.
• Serve as a resource and subject matter expert for pharmacy-related initiatives.
• Resolve issues and escalate to management as necessary, assisting with clinical and contractual matters.
• Oversee quality assurance of benefit plan administration with internal stakeholders and PBM account teams.
• Address escalated customer service inquiries and grievances, including pharmacy claim adjustments.
• Coordinate Pharmacy Coverage Determinations with Clinical Staff and external partners.
• Manage pharmacy claim reconsiderations and appeals with the Appeals department and external partners.
• Respond to and coordinate the review and approval of RFPs and government program applications.

Key Requirements and Technology Experience: 

• High school diploma or GED.
• 3+ years of experience in a related field.
• Strong experience in PBM and claims management.
• Proven ability to resolve customer service issues effectively.

Our client is a leading Health Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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