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Pharmacy Benefit Specialist II
CareOregon. Support CareOregon members, providers, and pharmacies with pharmacy benefit and prescription needs under the major medical benefit .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates advanced knowledge of medical and pharmaceutical terminology, along with proficiency in pharmacy benefit management and managed care concepts. Capable of providing exceptional customer service while maintaining compliance with HIPAA regulations.
Highest-signal resume keywords
Pharmacy Benefit ManagementManaged Care ExperiencePharmacy Technician Certification (CPhT)Microsoft Office ProficiencyAdvanced Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pharmacy Claims ProcessingData EntryClaims AdjudicationPrior Authorization ReviewsFormulary Exception ProcessesMedication History ReviewCost-Saving InitiativesDocumentation ManagementPharmacy Appeals ProcessingEligibility Verification
Soft Skills
Advanced Listening SkillsVerbal CommunicationWritten Communication
Tools & Technologies
CareOregon SoftwarePBM SoftwareDatabase SystemsSpreadsheet Systems
Certifications & Qualifications
Pharmacy Technician Certification (CPhT)
Industry Keywords
HIPAA ComplianceOregon Health PlanMedicare ConceptsPharmacy Benefit PoliciesCustomer Service
About the role
Key responsibilities & impact- Support CareOregon members, providers, and pharmacies with pharmacy benefit and prescription needs under the major medical benefit
- Provide customer service and process pharmacy claims
- Respond to drug coverage inquiries and educate members, providers, pharmacies, and staff about formularies and pharmacy benefit policies
- Document customer service activities and maintain confidentiality under HIPAA
- Perform data entry into claims processing, document management, database, and spreadsheet systems
- Sort incoming faxes and maintain files
- Assist with pharmacy projects, education materials, letters, mailings, and reports
- Verify plan eligibility and drug coverage benefits
- Review medication and eligibility history and load authorizations into claims adjudication platforms
- Assist with prior authorization, formulary exception, and coverage determination processes
- Perform prior authorization reviews with pharmacist oversight and communicate decisions
- Process pharmacy appeals and grievances, gather documentation, prepare cases for review, and notify members and providers of outcomes
- Assist with process improvements, cost-saving initiatives, benefit implementations/changes, and outreach projects under pharmacist or operations supervisor supervision
- Work Monday through Friday
Requirements
What you’ll need- Minimum 2 years of work experience on a pharmacy team or 2 years’ experience in a health insurance plan
- Minimum 1 year experience with managed care and/or pharmacy benefit management
- Advanced knowledge of medical and pharmaceutical terminology
- Substantial understanding of managed care, Medicare, and Oregon Health Plan concepts
- Proficient with Microsoft Office products and general computer literacy
- Ability to learn and navigate CareOregon and PBM software programs
- Advanced listening, verbal, and written communication skills
- Ability to perform repetitive finger and wrist movement for at least 6 hours/day
- Ability to hear and speak clearly for at least 3–6 hours/day
- Pharmacy Technician Certification (CPhT) preferred
- Pharmacy Technician experience preferred
- Pharmacy-related outbound calls experience preferred
Benefits
Comp & perks- Bonus opportunity; 5% annual SIP target
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account
- Flexible spending account(s)
- Lifestyle spending account
- Employee assistance program
- Wellness program
- Discounts
- Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings
- Retirement plan with employer contributions
- PTO
- Paid State Sick Time
- Paid holidays
- Volunteer time
- Jury duty leave
- Bereavement leave
- 401(k) contributions for non-benefits-eligible employees