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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 patient outreach while effectively utilizing AI-enabled tools for inquiry resolution. Strong ability to multitask and prioritize in a remote environment, ensuring quality assurance and compliance.
Highest-signal resume keywords
National Pharmacy Technician CertificationPharmacy Claims AdjudicationBenefit Design KnowledgePatient Outreach SupportDetail-Oriented Problem Solving
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 Adherence Follow-UpPrior Authorization CriteriaFormulary CoverageContract Standards Review
Soft Skills
EmpathyAdaptabilityAnalytical ThinkingMultitaskingTeam Collaboration
Tools & Technologies
AI-Enabled ToolsInternal Knowledge Systems
Certifications & Qualifications
National Pharmacy Technician Certification
Industry Keywords
Health PlanRetail PharmacyTPAPBM Contact CenterMail Order PharmacySpecialty Pharmacy
About the role
Key responsibilities & impact- Serve as a primary 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
- Process and review prescription claims for accuracy against benefit guidelines and contract standards
- 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 complete other assigned duties and projects
Requirements
What you’ll need- Associate's or bachelor's degree preferred, or equivalent relevant work experience
- Active/current National Pharmacy Technician Certification (PTCB or NHA)
- 1–3 years of experience as a pharmacy technician in a health plan, retail pharmacy, TPA, PBM contact center, mail order, or specialty pharmacy setting
- Working knowledge of pharmacy claims adjudication, benefit design, and PBM terminology
- Detail-oriented, adaptable, and analytical, with root-cause problem-solving ability
- Empathetic and intellectually curious, with a desire to improve members' healthcare experience
- Ability to multitask and prioritize across concurrent phone, chat, and email queues
- Ability to support multiple lines of business and shifting priorities
- Ability to work effectively in a fully remote environment and maintain reliable attendance
- Must reside in Florida, Texas, Georgia, or Tennessee
Benefits
Comp & perks- Fully remote work arrangement
- Seasonal/temporary assignment with October/November through February schedule
- Opportunity to work in a mission-driven healthcare company
- Inclusive culture and Equal Opportunity Employer commitment