FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in pharmacy claims adjudication, benefit design, and medication management while effectively communicating with members, providers, and pharmacies. Proficient in using AI-enabled tools for inquiry resolution and documentation, ensuring compliance and quality assurance.
Highest-signal resume keywords
National Pharmacy Technician CertificationPharmacy Claims AdjudicationBenefit Design KnowledgePatient Outreach SupportMultitasking and Prioritization
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 ProcessingMedication Cost AnalysisPrior Authorization CriteriaClinical Program EnrollmentDocumentation in Internal Systems
Soft Skills
Detail OrientedAdaptableAnalytical Problem SolvingCooperative Team EnvironmentEffective Communication
Tools & Technologies
AI-Enabled ToolsInternal Knowledge Systems
Certifications & Qualifications
National Pharmacy Technician Certification
Industry Keywords
Health PlanRetail PharmacyTPAPBM Contact CenterFormulary Coverage
About the role
Key responsibilities & impact- Serve as the primary point of contact for members, providers, and pharmacies via phone, chat, email, and written correspondence
- Resolve inquiries about mail order, benefit design, formulary coverage, medication cost, prior authorization criteria, and claims adjudication
- Assist network pharmacies with prescription claims processing and review claims for accuracy
- Support clinical pharmacists with patient and provider outreach, appointment scheduling, clinical program enrollment, and medication-adherence follow-up
- Document interactions and resolutions in internal systems for continuity of care, quality assurance, compliance, and reporting
- Own issues from initial contact through final resolution, coordinating with internal teams as needed
- Use AI-enabled tools and internal knowledge systems to resolve inquiries and document interactions
- Foster a cooperative, respectful, and diverse team environment and take on assigned duties and projects
Requirements
What you’ll need- Active/Current National Pharmacy Technician Certification (PTCB, NHA)
- 1 to 3 years as a pharmacy technician in a health plan, retail pharmacy setting, TPA, or PBM contact center role
- Working knowledge of pharmacy claims adjudication, benefit design, and PBM terminology
- Associate's or bachelor's degree preferred, or equivalent relevant work experience
- Detail oriented, adaptable, and analytical, with root cause problem-solving ability
- Ability to multitask and prioritize across concurrent phone, chat, and email queues
- Ability to support multiple lines of business and shifting priorities
