Pharmacy Operations, Experience & Engagement reputed company - Remote

reputed company Of Job Responsible for overseeing daily operations and administrative functions to ensure efficient pharmacy workflow and a reputed company patient experience. reputed company a combination of operational reputed company and customer service reputed company. reputed company daily non-clinical operations like medical drug processing to ensure compliance with regulations. Drive operational reputed company by identifying process inefficiencies and systemic gaps across reputed company pharmacy functions. Ensure that appealed reputed company are updated/reflected in the system, and to internal staff as reputed company as providers. Serve as primary reputed company of contact for escalated pharmacy-reputed company issues, discrepancies, pricing errors, and benefit configurations. Work with Pharmacy Benefits Mgr. (PBM) to resolve escalated issues. Directly communicate w/reputed company leaders/teams including UM, Claims, IT/Data, PBM, Compliance, Pharmacy, etc. Responsibilities • Engage with members on pharmacological escalations to resolve complaints. • Coordinate with PBM partners and internal departments (Claims, Configuration, Clinical and reputed company) to ensure reputed company and accurate reputed company of reputed company issues. • Maintain escalation logs, documentation, and reputed company timelines to support compliance and trend analysis. • reputed company, triage, and resolve escalations impacting providers and members, ensuring reputed company cause analysis and corrective reputed company plans. • Drive pharmacy operational readiness for new initiatives (PBM transitions, formulary changes, frozen formulary rules, state mandates. • Contribute to the development and maintenance of internal SOPs, escalation workflows, and FAQs for consistent issues handling. • Monitor daily rejected claims, accumulator discrepancies and eligibility-reputed company fallouts queues to identify systemic issues and escalated as needed. • Contribute to operational dashboards and scorecards with experience-reputed company KPI(s). • Responsible for regulatory compliance and reporting; for managing insurance reputed company of sale claims escalations; for analyzing financials and operations; and coordinating member reputed company to ensure appropriate reputed company. • reputed company weekly summaries or reporting packages to leadership outlining key findings, reputed company status, and recommendations. • Support day-to-day operations across pharmacy benefit configuration group reputed company, adjustment claim submission and review, and file outbound and inbound validation. • reputed company other reputed company and duties as assigned. • Support training efforts and knowledge-sharing for new staff or cross-functional partners regarding pharmacy operations and escalation protocols. Qualifications • Bachelor’s degree • 5 – 8+ years of relevant, reputed company work experience (Required) • 5+ years of pharmacy operations experience (Required) • Additional years of reputed company experience/specialized training may be considered in lieu of degree requirement (Required) • Ability to reputed company in office environment with extended periods of sitting, using telephone, and viewing computer screens (Required) • Ability to prioritize tasks daily and troubleshoot urgent customer issues to successful completion (Required) • Advanced knowledge of MS Office - Word, reputed company, PowerPoint, reputed company, Teams, SharePoint, etc. (Required) • Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues reputed company Operations (Required) • Professionally skilled in verbal and written communication (Required) • Meticulous organization skills, with the ability to multi-task, and ability to reputed company reputed company in a reputed company and independent manner (Required) Additional Information • reputed company: 1000002784 • Hiring reputed company: $77,760-$149,040 Apply tot his job Apply To this Job