Remote Pharmacy Benefits Specialist

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

Job summary

Rightway is seeking a Pharmacy Technician to join our Operations team as the first point of contact for members, providers, and pharmacies. You will handle benefits, prior authorization, claims, and clinical program enrollment across phone, chat, and email with empathy and problem solving.

You will document interactions, support claims adjudication, and assist with scheduling appointments and patient outreach, using AI-enabled tools to ensure timely, accurate, and consistent service.

Qualifications

• Diploma or equivalent relevant work experience.
• Active/Current National Pharmacy Technician Certification (PTCB, NHA).
• 1–3 years as a pharmacy technician in health plan, retail, TPA, or PBM contact center.
• Working knowledge of pharmacy claims adjudication, benefit design, and PBM terminology.

Responsibilities

• Serve as primary contact for members, providers, and pharmacies across phone, chat, email.
• Resolve inquiries on mail order, benefits, formulary, medication cost, prior authorizations, and claims.
• Support interactions across phone, chat, email and digital channels with consistent quality.
• Assist network pharmacies with processing and verifying prescription claims.
• Support pharmacists with outreach, scheduling, enrollment, and adherence follow-ups.
• Document interactions and resolutions in internal systems.
• Own issues from initial contact to resolution, coordinating with internal teams.
• Use AI tools and knowledge systems to resolve inquiries.
• Foster teamwork, respect, and diversity, and take on additional duties.

Skills

Pharmacy claims adjudication

PBM terminology

Multi-channel support

Root-cause analysis

Education

Diploma or equivalent

PTCB/NHA certification

Job description

Rightway is seeking a Pharmacy Technician to join our Operations team as the first point of contact for members, providers, and pharmacies. You will handle benefits, prior authorization, claims, and clinical program enrollment across phone, chat, and email with empathy and problem solving.

You will document interactions, support claims adjudication, and assist with scheduling appointments and patient outreach, using AI-enabled tools to ensure timely, accurate, and consistent service.