Remote Pharmacy Support Specialist - Bilingual EN/ES

Rightway; United States; On-site; USD 28,000 - 36,000; Full time

Job summary

Rightway today seeks a pharmacy support specialist to join the Operations team. You will be the frontline resource for members, providers, and pharmacies across phone, chat, and email, addressing benefits, prior authorization, claims, and program enrollment with empathy and accuracy.

You will assist networks with claims, ensure resolution of inquiries, and support clinical pharmacists through outreach and patient adherence efforts, documenting outcomes in internal systems.

Qualifications

• Bilingual English/Spanish required or preferred.
• Education: Associate's or Bachelor's degree preferred, or equivalent experience.
• Active National Pharmacy Technician Certification (PTCB/NHA) required.
• 1-3 years in a health plan, retail pharmacy, TPA, or PBM contact center role.
• Knowledge of pharmacy claims adjudication, benefit design, and PBM terminology.
• Detail oriented, empathetic, and strong cross-channel communication.

Responsibilities

• Serve as the primary point of contact for members, providers, and pharmacies across phone, chat, email, and written correspondence, delivering timely and accurate support.
• Field and resolve inquiries related to mail order, benefit design, formulary coverage, medication cost, prior authorization criteria, and claims adjudication.
• Seamlessly support interactions across phone, chat, email, and other digital channels while maintaining quality and service standards.
• Assist network pharmacies in processing prescription claims, reviewing claims for accuracy against benefit guidelines and contract standards.
• Support clinical pharmacists with patient and provider outreach, including scheduling appointments and enrolling members in Rightway clinical programs.
• Accurately document interactions and resolutions within internal systems to support continuity of care and reporting.
• Take ownership of member, provider, and pharmacy issues from initial contact through final resolution.
• Utilize AI-enabled tools and internal knowledge systems to resolve inquiries and deliver consistency.

Skills

Bilingual English/Spanish

Customer support

Pharmacy claims adjudication

Benefit design knowledge

Multitasking

Documentation & record-keeping

Education

Associate's or Bachelor's degree preferred, or equivalent work experience

Active/Current National Pharmacy Technician Certification (PTCB, NHA)

Tools

Pharmacy benefit management systems

Job description

Rightway today seeks a pharmacy support specialist to join the Operations team. You will be the frontline resource for members, providers, and pharmacies across phone, chat, and email, addressing benefits, prior authorization, claims, and program enrollment with empathy and accuracy.

You will assist networks with claims, ensure resolution of inquiries, and support clinical pharmacists through outreach and patient adherence efforts, documenting outcomes in internal systems.