Pharmacy Claims Specialist — Hybrid, Impactful Role

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

Job summary

National Rural Electric Cooperative Association seeks a Sr. Specialist, Pharmacy Claims in Lincoln, Nebraska to investigate and resolve pharmacy claim issues, serving as the go-to expert for benefit questions.

This role focuses on accurate, timely claims resolution within a hybrid work environment. The position requires extensive experience in prescription claims processing, PBM knowledge, and strong analytical and customer service skills, with at least 7 years in related fields.

Qualifications

• 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
• Insurance coursework such as LOMA, AHIP, ICA or CEBS, desired
• 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

Pharmacy claims processing

PBM knowledge

Analytical thinking

Customer service

Regulatory compliance

Communication

Microsoft Office

Education

Associate's degree in health administration or related

Medical terminology certification

Insurance coursework (LOMA/AHIP/ICA/CEBS)

Tools

Excel

Word

Outlook

PowerPoint

Job description

National Rural Electric Cooperative Association seeks a Sr. Specialist, Pharmacy Claims in Lincoln, Nebraska to investigate and resolve pharmacy claim issues, serving as the go-to expert for benefit questions.

This role focuses on accurate, timely claims resolution within a hybrid work environment. The position requires extensive experience in prescription claims processing, PBM knowledge, and strong analytical and customer service skills, with at least 7 years in related fields.