Remote Pharmacy Services Specialist | PBM & Claims Expert

Motion Recruitment; Durham (NC); Remote; USD 85,000 - 110,000; Full time

Job summary

Motion Recruitment is seeking a Pharmacy Services Specialist to support pharmacy benefit management operations remotely in North Carolina. The role focuses on coordinating PBM activities, RX claims, and prior authorization processes while serving as a subject matter expert for related initiatives.

You will collaborate with internal teams and external partners to resolve issues, manage contract workflows, and ensure compliance across programs.

Qualifications

• 5+ years of experience in a related field within health insurance or PBM.
• Experience with RX claims and prior authorization processes.
• Strong problem-solving and collaboration across internal and external teams.

Responsibilities

• Coordinate daily activities related to pharmacy benefit management operations.
• Support staff and coordinate tasks for programs, projects and initiatives.
• Serve as a subject matter expert for assigned initiatives and their impact on pharmacy needs.
• Resolve issues and escalate to management as appropriate; assist with clinical and contractual issues.
• Coordinate review, implementation, and QA of benefit plan administration with stakeholders and PBM team.
• Resolve or coordinate pharmacy claim adjustments and escalated customer inquiries with PBM and internal teams.
• Coordinate resolution of Pharmacy Coverage Determinations with Clinical Staff and external partners.
• Coordinate resolution of claim reconsiderations and appeals with Appeals department or partners.
• Respond to and coordinate review of RFPs, government applications and similar requests.
• Develop sourcing documents (RFP, RFI, RFQ) and manage status reporting for sourcing activities.
• Analyze market dynamics and share knowledge within portfolio of products and services.
• Partner with stakeholders to source products and services using analytics to drive results.
• Evaluate sourcing results from total cost of ownership and provide optimization recommendations.
• Participate in cross-functional teams for complex vendor negotiations and risk mitigation.
• Review and lead supplier relationship management within assigned category.
• Build relationships with vendor personnel and drive engagement.
• Coordinate vendor reviews and develop yearly vendor plans for assigned vendors.
• Coordinate vendor risk assessments and develop remediation plans.

Skills

PBM experience

Pharmacy operations

RX claims

Pharmacy technician

Prior authorization

Vendor management

Job description

Motion Recruitment is seeking a Pharmacy Services Specialist to support pharmacy benefit management operations remotely in North Carolina. The role focuses on coordinating PBM activities, RX claims, and prior authorization processes while serving as a subject matter expert for related initiatives.

You will collaborate with internal teams and external partners to resolve issues, manage contract workflows, and ensure compliance across programs.