Sr Specialist, Pharmacy Claims

CBA; Oklahoma; Hybrid; USD 68,000 - 80,000; Full time

Job summary

NRECA is seeking a Sr. Specialist, Pharmacy Claims in Lincoln, NE to resolve pharmacy claim issues and serve as the go-to expert for pharmacy benefit questions. You will work with internal and external partners to improve processes and ensure timely, accurate claims resolution.

The role follows a hybrid schedule, with work-from-home up to two days per week. Required: 7+ years in prescription claims processing; 5+ years in pharmacy or PBM in group insurance; strong PBM knowledge; adept at

Qualifications

• 7+ years of prescription claims processing experience for commercial carriers.
• 5+ years in a pharmacy setting or PBM in a group insured environment.
• Knowledge of PBM workflows, benefit design, and formulary processes.
• Strong regulatory knowledge (HIPAA, ACA, Medicare Part D).

Responsibilities

• Troubleshoot pharmacy claim issues and answer member/provider questions.
• Collaborate with internal/external partners to resolve complex concerns.
• Balance investigative work with high-quality customer service and process improvements.
• Identify opportunities to improve processes and prevent future issues.

Skills

Pharmacy claims processing

PBM knowledge

Analytical thinking

Customer service

Verbal & written communication

Presentation/training

Regulatory knowledge (HIPAA/ ACA)

Education

Associate degree in health administration or related field

Insurance coursework (LOMA/AHIP/ICA/CEBS)

Tools

Microsoft Office

Job description

Sr. Specialist, Pharmacy Claims

Location: Lincoln, Nebraska

Join a Mission-Driven Organization We're seeking a problem-solver who enjoys tackling complex challenges, investigating and resolving pharmacy claim issues, and delivering exceptional service to our members. Join our Medical Claims team in Lincoln, NE, and make a meaningful impact by helping ensure accurate and timely claims resolution We’re proud to be named one of Lincoln’s Best Places to Work—and we’re looking for people who care deeply about helping others and want to grow with a mission-driven organization.

About NRECA

NRECA is the national trade association representing more than 900 consumer-owned electric cooperatives across the United States. We provide advocacy, financial services, and business solutions that help over 900 consumer-owned electric cooperatives across the country serve their communities and we operate with integrity, transparency, and a spirit of innovation. The work in the Insurance & Financial Services department (I&FS) is dynamic and intellectually challenging, engaging, and deeply impactful. They work to develop and administer employee benefit plans and services which are diverse and the results help improve the quality of life for hard working Americans across the country. They foster a culture that emphasizes a strong sense of diversity, integrity, and belonging, driven by NRECA’s core values like communication, creative problem-solving, collaboration and accountability. If you’re motivated by purpose, enjoy variety, and care about people and outcomes, this is the team for you.

Position Summary

As a Sr. Specialist, Pharmacy Claims, you'll resolve pharmacy claim issues, be the go-to expert for pharmacy benefit questions and escalation, and identify opportunities to improve processes, systems, and service delivery. The work schedule is 8:15 a.m. to 5:00 p.m. and the position is eligible for NRECA’s hybrid schedule which allows flexibility to work from home up to 2 days per/week.

Key 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.

Education, Experience, and Certifications

Required Education and Certifications: 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.

Preferred Education: Insurance coursework such as LOMA, AHIP, ICA or CEBS, desired.

Required Experience: 7 or more 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.

Knowledge, Skills and Abilities

• Knowledge of pharmacy benefit management (PBM), including benefit design, coverage limitations, and formulary processes.
• Understanding of applicable regulations, including HIPAA, ACA, Medicare Part D, and other federal mandates.
• Knowledge of pharmacy and health claims operations, compliance requirements, and contractual plan language, with the ability to interpret and apply medical, technical, and contractual information to claims.
• Strong analytical and critical thinking skills, with the ability to identify issues, evaluate information, and draw sound conclusions.
• Excellent interpersonal and customer service skills.
• Effective verbal and written communication skills, with the ability to interact professionally with members, employees, and vendors.
• Ability to exercise sound judgment, discretion, and decision-making in a fast-paced environment.
• Proficiency with Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.
• Ability to develop and deliver presentations, training, and educational sessions.
• Ability to report to the office as required.

Essential Physical Requirements

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job. Primarily sedentary work with extended periods of sitting. Visual acuity is sufficient for computer work and data analysis. Manual dexterity for frequent keyboard use. Occasional light lifting (up to 10 lbs). Effective communication in person, by phone, and via email.

Salary Range

Salary Range: $68,000 - $80,000. Final Compensation determined by individual qualifications, experience, and internal equity.

Disclaimer Statement

The preceding job description has been written to reflect management’s assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned.

Additional Requirement: The preceding job description has been written to reflect management’s assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned.

Equal Opportunity Statement

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. NRECA is committed to working with and providing reasonable accommodation to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail [e-mail] or call: 703-907-5992 - NRECA Arlington Human Resources. Please call 402-483-9275 - NRECA Lincoln Human Resources, for Lincoln, NE employment opportunities. We will make a determination on your request for reasonable accommodation on a case-by-case basis.

Compliance and Pay Transparency

The U.S. Equal Employment Opportunity Commission (EEOC) recently released the 'Know Your Rights' poster, which updates and replaces the previous "EEO is the Law" poster and "EEO Is the Law Poster Supplement". Pay Transparency Non-Discrimination. NRECA will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. Please see the Pay Transparency Nondiscrimination Provision for more information.

E-Verify

As a Federal Contractor, NRECA is required to participate in the E-Verify Program to confirm eligibility to work in the United States. For information please click on the following link: E-Verify. For more information about life at NRECA please visit www.Electric.coop.

More About NRECA

Learn more about who we are, career opportunities, employer awards and life at NRECA. The National Rural Electric Cooperative Association (NRECA), with offices in Arlington, VA and Lincoln, NE is the trade association for over 900 consumer-owned electric cooperatives serving more than 42 million people. At NRECA, we work with people who are leaders in their fields. They are down-to-earth, hardworking professionals committed to helping our members serve their communities. Our work is interesting, constantly evolving, and requires new skills to meet the changing needs of a dynamic industry. Employees are united around the compelling purpose and history of electric cooperatives which allows teams and individuals to thrive as they collaborate and engage to accomplish great things in the pursuit of our mission. And topping it off, NRECA cares about each person’s overall well-being, encouraging health, financial security, and a sustainable work/life balance. Learn more about who we are at https://www.electric.coop/our-organization/careers.