Pharmacy Care & Claims Specialist

WellDyne; United States; À distance; USD 40 000 - 56 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Pharmacy claims processing

Analytical skills

Troubleshooting

Regulatory compliance

Customer service

Formation

High school diploma or equivalent

Active Pharmacy Technician registration/certification

1-2 years pharmacy/customer service experience

Experience processing/reprocessing pharmacy benefit claims

Description du poste

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