Pharmacy Operations Specialist

5G-Starlink Pte.; Singapore; On-site; SGD 40,000 - 65,000; Full time

Job summary

A nonprofit health insurance company in Singapore seeks a Pharmacy Operations Specialist to support pharmacy utilization management programs and provide customer service to both internal and external parties. This role requires at least two years of professional experience in a pharmacy setting and strong communication and organizational skills. The ideal candidate will process prior authorization requests and assist with clinical program implementation. Competitive compensation is offered in line with industry standards.

Qualifications

• Two or more years of experience in a professional or pharmacy setting.
• Previous experience in a managed care environment preferred.
• Prior customer service experience preferred.

Responsibilities

• Receive, process, and review all prior authorization requests.
• Apply clinical policy criteria to prior authorization requests.
• Communicate determinations to members and providers.
• Provide pharmacy-related customer service to internal and external parties.

Skills

Organizational skills

Problem-solving skills

Communication skills

Interpersonal skills

Data entry attention to detail

Education

Minimum of a High School diploma or equivalent

Associate or Bachelor's degree preferred

Job description

About the job Pharmacy Operations Specialist

Its an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Reporting to the Manager of Pharmacy Operations, the Pharmacy Operations Specialist is primarily responsible for supporting the pharmacy utilization management programs, processing prior authorization requests, and providing pharmacy-related customer service to internal and external parties.

In addition, the Operations Specialist will support the day‑to‑day operations of the pharmacy program as needed.

Our Investment In You

Key Functions/Responsibilities

• Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements.
• Properly apply clinical policy criteria to the review of prior authorization requests.
• Review and interpret members eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email.
• Interpret medical and pharmacy data and accurately enter information into system according to regulatory and NCQA accreditation requirements.
• Communicate determinations to members and providers via incoming and outgoing telephone calls, fax notifications, and letter notifications.
• Responsible for analysis and issue resolution as it pertains to the administration of the formulary and benefits.
• Provide pharmacy‑related customer service to both internal and external parties.
• Process pharmacy authorizations utilizing PBM real‑time online claims adjudication software.
• Support new clinical program implementation.
• Serve as a liaison to Member Services and other internal clients for real‑time support on pharmacy benefit interpretation, Pharmacy Policy interpretation, and plan design interpretation.
• Other responsibilities as needed.

Education

• Minimum of a High School diploma or equivalent required. Associate or Bachelors degree preferred.

Experience

• Two or more years of experience in a professional or pharmacy setting.
• Previous experience in a managed care environment preferred.
• Prior customer service experience preferred.

Competencies, Skills, And Attributes

• Prior experience assisting members and/or providers with telephone inquiries.
• Strong organizational, problem‑solving, communication, and interpersonal skills.
• Excellent written and oral communication skills required.
• Must have strong data entry and attention to detail in building cases.
• Must be able to multitask and be results oriented.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high‑quality health plans and services that work for our members, no matter their circumstances.

Additional Information

WellSense will require proof of COVID‑19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.