Pharmacy Benefits Specialist

ExactCare

. Answer telephone inquiries in a pleasant, professional, and efficient manner .

Posted 10/7/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in customer service within the healthcare industry, with a strong focus on communication, problem-solving, and adherence to HIPAA guidelines. Proficient in claims processing, prior authorization requests, and maintaining knowledge of Medicare guidelines and pharmacological terms.

Highest-signal resume keywords

Customer Service ExperiencePharmacy Support RoleCPhT CertificationKnowledge of Medicare GuidelinesClaims Adjudication Software

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingPrior Authorization RequestsPharmacology KnowledgeDetail OrientationProblem Solving Under PressureDatabase Software ProficiencyWord Processor ProficiencySpreadsheet Proficiency

Soft Skills

Excellent Communication SkillsProfessionalismAbility to Prioritize Workload

Tools & Technologies

JIRA SoftwareClaims Adjudication Software

Certifications & Qualifications

CPhT Certification

Industry Keywords

Healthcare IndustryMedicare Part D GuidelinesPlan and Benefit StructuresHIPAA Compliance

About the role

Key responsibilities & impact

Answer telephone inquiries in a pleasant, professional, and efficient manner
Provide timely and accurate responses to clients, including members, clinicians, pharmacies, plan sponsors, and internal departments
Document incoming calls and dialogue in claims adjudication software
Educate clients on plan policies, benefits, and procedures
Resolve medical, financial, or technological drug benefit concerns
Initiate and facilitate prior authorization requests
Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets
Review after-hours call logs and complete follow-up as needed
Submit JIRA tickets for compound prescriptions
Submit JIRA tickets to resolve NDC issues, including pricing issues and missing NDCs
Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines
Perform direct member reimbursement, processing, manual claims, reporting, and rejected-claim research as assigned
Ensure HIPAA guidelines are followed in every client communication
Embody AnewHealth’s Core Values in communications and interactions
Travel to special organization or department events, team meetings, trade shows, conferences, and other client engagements when required

Requirements

What you’ll need

Associate’s degree or equivalent combination of education or work experience
Preferred CPhT (Certified Pharmacy Technician) Certification
Minimum 3 years of customer service/member service experience in a call center or similar environment
Minimum 2 years of experience in the healthcare industry
Minimum 2 years of experience in a pharmacy support role
Knowledge of plan and benefit structures and Medicare guidelines
Knowledge of pharmacology and pharmacological terms
Excellent communication skills and professionalism when working with clients
Ability to solve problems under pressure by making immediate decisions while on the phone
Detail oriented and able to prioritize workload
Strong computer skills including using word processors, spreadsheets, and database software
Availability outside of normal business hours on an ad-hoc basis
Ability to work scheduled hours from 11:30am to 8:00pm Eastern Standard Time
Applicants must be eligible to work in this country