Pharmacy Benefits Specialist I - Hybrid/Remote

Network Health; Menasha (WI); Hybrid; USD 42,000 - 56,000; Full time

Job summary

Network Health is seeking a Pharmacy Benefits Specialist I to support operational, planning, implementation and reporting for the Pharmaceutical Benefits area. You will build report queries, maintain financial reports, and resolve claim processing and benefit issues, acting as a resource on pharmacy benefits.

The role is based in Wisconsin with a hybrid work arrangement and standard 40-hour weeks. A Pharmacy Technician certification is preferred, with one year of related experience required.

Qualifications

• High School Diploma or equivalency required.
• One year of experience in a Pharmacy Tech position or one year of experience working with pharmacy benefits required.
• Certified Pharmacy Technician preferred.
• One (1) year of experience working with pharmacy benefits may substitute for certification.

Responsibilities

• Manage large mailings including letter preparation and mail merge.
• Create and maintain Prescription Benefit Summary of Member Responsibility Tables.
• Produce reports for Prior Authorization, physician utilization, and KPI board metrics.
• Research and resolution of benefit issues; review denials and manage related tasks.
• Assist with benefit testing and respond to formulary status questions.

Education

High School Diploma

Certified Pharmacy Technician

Job description

Network Health is seeking a Pharmacy Benefits Specialist I to support operational, planning, implementation and reporting for the Pharmaceutical Benefits area. You will build report queries, maintain financial reports, and resolve claim processing and benefit issues, acting as a resource on pharmacy benefits.

The role is based in Wisconsin with a hybrid work arrangement and standard 40-hour weeks. A Pharmacy Technician certification is preferred, with one year of related experience required.