Medicare Pharmacy Technician: PBM Claims & PA Specialist

AlohaCare; Wailuku (HI); On-site; USD 28,000 - 36,000; Full time

Job summary

AlohaCare is seeking a Pharmacy Technician to support Medicare operations delegated to our PBM, including outreach on rejected claims, prior authorization processing, and review of coverage determinations. The role supports formulary management and compliance within the AlohaCare Pharmacy Department.

Ideal candidates have at least 2 years of pharmacy experience, strong data entry skills, and the ability to work independently in a fast-paced environment.

Qualifications

• Pharmacy tech with 2+ years experience in pharmacy operations.
• Ability to type 45 WPM with high accuracy.
• Experience with PBM or drug claims processing is a plus.

Responsibilities

• Oversee PBM Medicare Part D/B operations and audit reports.
• Resolve Part D/B claim issues with PBM operations team.
• Prepare Medicare appeal/grievance cases for review.
• Assist in Medicare claim processing and prior authorization workflows.
• Maintain regulatory compliance and confidentiality.

Skills

Pharmacy experience

Typing speed 45 wpm

Data entry accuracy

Time management

Independent worker

Adapt to fast-paced environment

Education

Nationally Certified Pharmacy Technician (CPhT)

Science-related college degree

Tools

QMACS

PBM systems

Microsoft Word/Excel/Outlook/PowerPoint

Job description

AlohaCare is seeking a Pharmacy Technician to support Medicare operations delegated to our PBM, including outreach on rejected claims, prior authorization processing, and review of coverage determinations. The role supports formulary management and compliance within the AlohaCare Pharmacy Department.

Ideal candidates have at least 2 years of pharmacy experience, strong data entry skills, and the ability to work independently in a fast-paced environment.