Employer Industry: Health Insurance

Why consider this job opportunity:
- Salary up to $58,800
- Comprehensive health benefits (Medical/Dental/Vision)
- Generous paid time off (PTO) and paid volunteer time off
- Opportunities for career advancement and professional development
- Supportive and inclusive work environment
- Incentive plans and wellness programs

What to Expect (Job Responsibilities):
- Handle all telephonic interactions regarding Pharmacy eligibility, coverage determinations, and claims issues
- Collaborate with physicians and pharmacists to ensure formulary compliance and optimize generic dispensing
- Capture and evaluate clinical information for Prior Authorization requests to determine medical necessity
- Process complaints, appeals, grievances, and compliance-related issues
- Identify instances of potential fraud, waste, and abuse during member and provider interactions

What is Required (Qualifications):
- High School Diploma or GED required
- Minimum of two (2) years of 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 common medical terminology

How to Stand Out (Preferred Qualifications):
- Minimum of two (2) years of experience in third-party prescription program claim adjudication
- Experience in a retail pharmacy or relevant pharmacy experience in managed care or a PBM organization

#HealthInsurance #PharmacyServices #CustomerService #CareerOpportunity #CompetitivePay

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