The Associate Pharmacy Operations Coordinator is responsible for facilitating the administration of Harvard Pilgrim’s pharmacy benefits. With appropriate training, this individual must understand our pharmacy benefits and products, and work with Member Services to resolve commonly occurring pharmacy claims issues. Additionally, this individual, with supervision, will manage the intake process for member appeals and benefit exceptions and reconsiderations, triaging any issues for appropriate follow-up and resolution, and responding to inquiries from network pharmacies and health care providers.
Monitor, service and accurately administer Harvard Pilgrim’s pharmacy benefits and policies via the PBM’s (pharmacy benefit manager) claims adjudication and authorization systems.
Collaborate with Member Services to identify and resolve pharmacy benefit issues that may impact our members, providers or pharmacies.
Respond to pharmacy benefit inquiries from internal and external customers (i.e., providers, pharmacies and members).
Manage the intake and processing of member appeals, benefit exceptions and reconsiderations.
Maintain a log of customer inquiries or complaints and appropriately triage to ensure resolution.
Must share in rotating department responsibility for 24/7 on-call pager, to ensure excellent customer service.
Other duties and projects as assigned.
High School diploma; undergraduate (2-year or 4-year) degree preferred. Pharmacy Technician certification preferred.
2+ years working in a managed care environment; pharmacy operations preferred
Customer service orientation; effective verbal and written skills
Demonstrated ability to interact well at all levels of an organization
Good organizational skills
Aptitude for learning new technologies – systems, applications, devices
Ability to work in a team and independently, with some supervision
Harvard Pilgrim Health Care - 30+ days ago
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