Pharmacy Claims Expert — Hybrid Schedule

National Rural Electric Cooperative Association (NRECA); Lincoln (NE); Hybrid; USD 68,000 - 80,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

NRECA in Lincoln, Nebraska is seeking a Sr. Specialist, Pharmacy Claims to resolve pharmacy claim issues and serve as the go-to expert for benefit questions. You will help identify opportunities to improve processes and service delivery.

The role supports the Insurance & Financial Services team and offers a hybrid schedule with up to two days remote per week, with a salary range of $68,000 to $80,000 depending on qualifications and experience.

Qualifications

• Required Education and Certifications: Associate’s degree in a related field (health administration, pharmacy technician, desired), or combination of education and experience; Certification in a medical terminology course or coursework in medical anatomy.
• Preferred Education: Insurance coursework such as LOMA, AHIP, ICA or CEBS, desired.
• Required Experience: 7+ years of experience with prescription claims processing for commercial insurance carriers; 5 years of experience working in a pharmacy; or 5 years’ experience with a PBM in a group insurance setting.

Responsibilities

• Troubleshoot pharmacy claim issues
• Answer questions from members and providers
• Work with internal and external partners to resolve complex benefit concerns
• Balance investigative work with customer service while also looking for opportunities to improve processes and prevent future issues

Skills

PBM knowledge

HIPAA knowledge

Analytical thinking

Customer service

Verbal & written communication

Decision making

Presentation/training

Cross-functional collaboration

Education

Associate’s degree in health administration or pharmacy tech

LOMA/AHIP/ICA/CEBS coursework or certifications

Tools

Excel

Word

Outlook

PowerPoint

Job description

NRECA in Lincoln, Nebraska is seeking a Sr. Specialist, Pharmacy Claims to resolve pharmacy claim issues and serve as the go-to expert for benefit questions. You will help identify opportunities to improve processes and service delivery.

The role supports the Insurance & Financial Services team and offers a hybrid schedule with up to two days remote per week, with a salary range of $68,000 to $80,000 depending on qualifications and experience.