Customer Care Pharmacy Support Specialist

WellDyne; United States; Remote; USD 40,000 - 56,000; Full time

Job summary

WellDyne is seeking a Customer Care Pharmacy Support Specialist to assist partner clients, patients and providers with pharmacy and claim inquiries. This role combines inbound contact center expertise with pharmacy technician knowledge to research, troubleshoot, and reprocess claims for authorized partner clients.

As a subject matter expert, you will collaborate with Pharmacy, Client Services and Operations to ensure accurate claim resolution, quality customer experiences, and adherence to

Qualifications

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license or certification required.
• 1-2 years pharmacy/customer service experience preferred.
• Experience processing or reprocessing pharmacy benefit claims strongly preferred.

Responsibilities

• Provide advanced support for complex patient, pharmacy, provider, and client inquiries.
• Validate claim information, eligibility, benefit requirements, and other applicable information before initiating an authorized claim reprocessing transaction.
• Reprocess pharmacy claims for authorized partner clients in accordance with client-specific requirements, approved procedures, assigned system permissions, and applicable regulatory requirements.
• Serve as a subject matter expert and escalation resource for Customer Care.
• Advocates regarding pharmacy benefits, claims, systems, and client-specific processes.
• Follow-up with patients as needed to ensure medication orders are processed.
• Support patients, providers and members with pharmacy mail order coordination.
• Handle sensitive and escalated customer interactions requiring advanced research, judgment, and problem-solving.
• Perform authorized pharmacy technician functions within applicable laws, regulations, organizational procedures, and the defined scope of the position.
• Ensure compliance with HIPAA, applicable pharmacy requirements, client requirements, and organizational policies.
• Perform additional duties as assigned.

Skills

Pharmacy claims processing

Analytical skills

Troubleshooting

Regulatory compliance

Customer service

Education

High school diploma or equivalent

Active Pharmacy Technician registration/certification

1-2 years pharmacy/customer service experience

Experience processing/reprocessing pharmacy benefit claims

Job description

At our company, we move fast, adapt quickly, and turn challenges into opportunities—allwhile keeping quality at the heart of everything we do. We believe that work should be apositive and respectful place, and that with the right mindset, anything is achievable.

Our Vision

Fulfill the essential promise of pharmacy care and help people to live to their healthiest,happiest, and fullest potential.

Our Mission

To be the disruptive force that drives meaningful change within pharmacy services.

Shifts: Monday to Friday:

• 8am-430pm
• 9am-530pm
• 930am-6pm

Summary

The Customer Care Pharmacy Support Specialist is a Customer Care position responsiblefor supporting partner clients, patients and providers with pharmacy and prescriptionclaim inquiries. This role combines inbound contact center and expertise with pharmacytechnician knowledge and the ability to research, troubleshoot, and reprocess pharmacyclaims for authorized partner clients. The position serves as a subject matter expert and analytical resource within Customer Care while collaborating with the Pharmacy, ClientServices, and Operations. Success in this role is demonstrated through accurate claimresolution, quality customer experiences, appropriate claim reprocessing, and adherenceto client, regulatory, and organizational requirements. This position reports to the Manageror Supervisor, Customer Care.

Essential Duties and Responsibilities

• Provide advanced support for complex patient, pharmacy, provider, and clientinquiries across supported lines of business.
• Validate claim information, eligibility, benefit requirements, and other applicableinformation before initiating an authorized claim reprocessing transaction.
• Reprocess pharmacy claims for authorized partner clients in accordance withclient-specific requirements, approved procedures, assigned system permissions,and applicable regulatory requirements.
• Serve as a subject matter expert and escalation resource for Customer Care
• Advocates regarding pharmacy benefits, claims, systems, and client-specificprocesses.
• Follow-up with patients as needed to ensure medication orders are processed.
• Support patients, providers and members with pharmacy mail order coordination.
• Handle sensitive and escalated customer interactions requiring advanced research,judgment, and problem-solving.
• Perform authorized pharmacy technician functions within applicable laws,regulations, organizational procedures, and the defined scope of the position.
• Ensure compliance with HIPAA, applicable pharmacy requirements, clientrequirements, and organizational policies.
• Perform additional duties as assigned.

Education and Experience

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license or certification required.
• 1-2 years pharmacy/customer service experience preferred.
• Experience processing or reprocessing pharmacy benefit claims strongly preferred.

Knowledge, Skills and Abilities

• Experience processing or reprocessing pharmacy benefit claims strongly preferred.
• Ability to reprocess pharmacy claims accurately within assigned system
• permissions and established procedures.
• Strong analytical, troubleshooting, critical-thinking, and problem-solving skills.
• Ability to distinguish issues that can be resolved operationally from those requiring
• pharmacist, clinical, configuration, compliance, or leadership intervention.
• Ability to work independently and collaboratively in a fast-paced Customer Care
• Ability to maintain confidentiality and handle sensitive information with integrity.

Work Environment / Physical Demands

This position is in a typical office environment which requires prolonged sitting in front of acomputer. Requires hand-eye coordination and manual dexterity sufficient to operatestandard office equipment including operation of standard computer and phoneequipment. May have occasional high stress when dealing with customers/clients. Sometravel may be required. EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibitsdiscrimination of any kind. All employment decisions are based on business needs, jobrequirements, and individual qualifications, without regard to race, color, religion, gender,sexual orientation, gender identity, national origin, veteran or disability status, or any otherprotected status under federal, state, or local law.