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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management and member engagement, focusing on specialty pharmacy solutions while ensuring compliance with HIPAA and ERISA regulations. Proven ability to collaborate with healthcare providers and deliver personalized service to optimize drug spending and enhance member satisfaction.
Highest-signal resume keywords
Case ManagementSpecialty Pharmacy ExperienceMember EngagementHIPAA ComplianceCRM Platform Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Specialty PharmacyDrug Cost AnalysisClaims UnderstandingCost Sharing KnowledgeSite-of-Service Transitions
Soft Skills
EmpathyEffective ListeningCompassionIntegrityDiscretion
Tools & Technologies
CRM Platform
Certifications & Qualifications
HIPAA Training
Industry Keywords
PBMERISAMember-Centric SolutionsHealthcare CollaborationCost-Saving Methods
About the role
Key responsibilities & impact- Conduct case management on behalf of clients and Southern Scripts to manage specialty drug spending and generate savings
- Identify lowest-cost drug solutions while maintaining a high-touch, member-centric relationship
- Provide targeted, personalized service based on members’ benefits, health information, and engagement
- Coordinate site-of-service transitions and other RxCompass cost-saving methods
- Engage members and providers by telephone, written correspondence, fax, or app
- Consult and educate members and providers through individualized programs
- Help members understand claims, accumulators, usage, balances, and cost sharing
- Develop, present, and implement member-centric solutions that reduce specialty medication costs
- Handle referrals within required turnaround times
- Support client expectations for efficiency, service levels, privacy, and decision quality
- Maintain compliance with ERISA, HIPAA, and client-specific requirements
- Collaborate with medical and pharmacy providers, hospitals, members, home infusion providers, and other vendors
- Report HIPAA violations to the Compliance Officer and/or Human Resources
- Work as part of the team to meet business-unit objectives and adapt to change
Requirements
What you’ll need- High School degree, some college preferred or equivalent experience
- 1-2 years’ experience with member engagement with PBM and Medical background
- 1-2 years’ Specialty Pharmacy or PBM experience
- 1-2 years’ CRM platform experience
- 1-2 years’ experience collaborating with Clinical, Prior Authorization, sales, account management, senior executive, and various external client-facing relationships
- Availability during core work hours of 8:00 AM to 5:00 PM CT
- Ability to adjust work times to cover meetings in all time zones
- Ability to work extended hours, weekends, and holidays as needed
- Ability to travel overnight from remote location
- Ability to deal with a diverse customer base in a friendly manner
- Empathy and effective listening skills
- Proven background in medical/pharmacy benefits, particularly specialty medications
- Ability to balance compassion, integrity, discretion, and sound judgment
- Compliance with HIPAA, ERISA, and client-specific requirements
- Attendance, completion, and demonstrated competency in required HIPAA training
Benefits
Comp & perks- Full-time hourly/non-exempt position
- Some flexibility in hours
- Remote work arrangement
- Equal employment opportunity and nondiscrimination protections