Pharmacy Benefits Support Specialist

Rightway; United States; On-site; USD 30,000 - 31,000; Full time

Job summary

Rightway is seeking a Pharmacy Technician to join its Operations team in the United States. You’ll be the first point of contact for members, providers, and pharmacies across phone, chat, and email, delivering empathetic and accurate support on benefits, prior authorization, and claims.

With 1–3 years in a health plan or PBM setting and a current PTCB/NHA certification, you’ll handle claims adjudication, enrollment in Rightway programs, and medication adherence outreach, documenting interactions

Qualifications

• Education: associate's or bachelor's degree preferred, or equivalent relevant work experience.
• Certification: Active/Current National Pharmacy Technician Certification (PTCB, NHA)
• Experience: 1 to 3 years as a pharmacy technician in a health plan, retail pharmacy setting, TPA, or PBM contact center role.
• Working knowledge of pharmacy claims adjudication, benefit design, and PBM terminology.
• Detail oriented, adaptable, and analytical, with the ability to dig past a symptom to find and resolve the true root cause.
• Empathetic and intellectually curious, with a genuine desire to improve a member's healthcare experience and deliver concierge level service across every channel.
• Comfortable multitasking and prioritizing across concurrent phone, chat, and email queues, with the independence to manage your own workload.
• Comfortable supporting multiple lines of business and shifting priorities based on business needs, seasonal demand, and service levels.

Responsibilities

• Serve as the primary point of contact for members, providers, and pharmacies across phone, chat, email, and written correspondence, delivering timely and accurate support regardless of communication channel.
• Field and resolve inquiries related to mail order, benefit design, formulary coverage, medication cost, prior authorization criteria, and claims adjudication.
• Seamlessly support interactions across phone, chat, email, and other digital channels while maintaining consistent quality and service standards.
• Assist network pharmacies in processing prescription claims, reviewing claims for accuracy against benefit guidelines and contract standards.
• Support clinical pharmacists with patient and provider outreach, including scheduling appointments, enrolling members in Rightway clinical programs, and following up on medication adherence.
• Accurately document interactions and resolutions within internal systems to support continuity of care, quality assurance, compliance requirements, and operational reporting.
• Take ownership of member, provider, and pharmacy issues from initial contact through final resolution, coordinating with internal teams when necessary to ensure timely and complete resolution.
• Utilize AI-enabled tools and internal knowledge systems to efficiently resolve inquiries, document interactions, and deliver a consistent member experience.
• Foster a team environment that values cooperation, respect, and diversity, and take on other duties and projects as assigned.

Skills

Empathy

Problem solving

Customer service

Communication

Attention to detail

Multitasking

Education

Associate's or Bachelor's degree preferred

Tools

Internal systems

Job description

Rightway is seeking a Pharmacy Technician to join its Operations team in the United States. You’ll be the first point of contact for members, providers, and pharmacies across phone, chat, and email, delivering empathetic and accurate support on benefits, prior authorization, and claims.

With 1–3 years in a health plan or PBM setting and a current PTCB/NHA certification, you’ll handle claims adjudication, enrollment in Rightway programs, and medication adherence outreach, documenting interactions