Senior Pharmacy Operations & Appeals Lead

Midwest Operating Engineers Fringe Benefit Fund; Lyons Township (IL); On-site; USD 85,000 - 90,000; Full time

Job summary

Midwest Operating Engineers Fringe Benefit Fund in Countryside, IL seeks a Senior Pharmacy Coordinator to support the Pharmacy Manager with day-to-day operations, complex member issues, and appeals administration, ensuring accuracy and compliance with plan provisions.

The role requires strong Excel and PowerPoint skills, experience with PBMs, health plans, and data analytics, plus the ability to communicate with members, providers, and internal teams.

Qualifications

• Bachelor's degree in related field preferred.
• Three to five years of experience in a retail pharmacy, specialty pharmacy, PBM, health plan, or other pharmacy-related settings.
• Experience working with pharmacy benefits, including prior authorizations, pharmacy claims processing, formularies, utilization management programs, and Medicare Part D.
• Experience handling calls and researching and resolving member, provider, and pharmacy inquiries.
• Advanced proficiency in Microsoft Excel and PowerPoint.
• Experience with Salesforce, Microsoft Teams, Zoom, Outlook, or similar business applications.

Responsibilities

• Handle member inquiries from start to finish with timely communication.
• Collaborate with internal departments, vendors, providers, pharmacies, and other stakeholders to obtain information and address inquiries.
• Maintain appeal tracking logs and case records, ensuring activities, determinations, status updates and timelines are accurately documented.
• Prepare appeal summaries and supporting materials for Manager review.
• Review Prior Authorization reports and analyze trends for improvement.

Skills

Communication skills

Analytical thinking

Teamwork

Prioritization

Education

Bachelor's degree in related field

Tools

Excel

PowerPoint

Salesforce

Microsoft Teams

Zoom

Outlook

Job description

Midwest Operating Engineers Fringe Benefit Fund in Countryside, IL seeks a Senior Pharmacy Coordinator to support the Pharmacy Manager with day-to-day operations, complex member issues, and appeals administration, ensuring accuracy and compliance with plan provisions.

The role requires strong Excel and PowerPoint skills, experience with PBMs, health plans, and data analytics, plus the ability to communicate with members, providers, and internal teams.