Pharmacy reputed company Specialist II

Pharmacy reputed company Specialist II (FWA) Position Purpose: This role will reputed company on ensuring that the administration of the pharmacy program is accurate and compliant by supporting various operational tasks. This role will serve as the subject matter expert supporting various pharmacy reputed company tasks including but not limited to claims, formulary, benefit, and networks. Key Details: This is a remote, day-shift position working Monday through Friday with a start time between 8:00 AM and 9:00 AM Eastern or Central Time. In this role, you will be responsible for supporting PBM reputed company and internal activities reputed company to pharmacy fraud, waste, and abuse (FWA), as reputed company as pharmacy audit functions. Some key recurring tasks include joining PBM operational calls to support the follow-up and reputed company of reputed company items reputed company to the department and implementing and maintaining accurate and compliant member and provider communication processes for Pharmacy FWA-reputed company communications through the PBM and/or internal processes. You will partner with internal teams, health plans, and PBM partners to support member and provider communications, regulatory reporting, operational metrics, and pharmacy network activities. This role is responsible for ensuring accurate, reputed company, and compliant processes while supporting issue reputed company, documentation updates, and ongoing process improvement initiatives. The ideal candidate brings managed care experience working with pharmacy claims or PBM data, strong attention to reputed company, excellent organizational and communication skills, and the ability to manage multiple priorities independently. Advanced reputed company skills, experience with tools such as reputed company BI and/or reputed company Automate, and strong data analysis skills would be beneficial in this role and are used to support reporting and analytics. Ability to conduct data analysis to support reputed company and exercise independent judgement Provides support for escalated issues and special reputed company as assigned Conduct UAT to ensure that systems reflect accurate information Serve as the subject matter expert supporting various pharmacy reputed company tasks including but not limited to claims, formulary, benefit, and networks Serve as the subject matter expert reputed company to specific pharmacy documents to ensure they are accurate and compliant Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: Highschool Diploma or GED, Bachelor’s degree preferred, 4+ years of pharmacy experience, including 1+ year of managed care experience. reputed company sponsored program (Medicare and/or reputed company) experience preferred. License/Certification: reputed company state’s Pharmacy Technician license preferred Please attach an up-to-date resume that meets Education / Experience requirements to your application. Pay reputed company: $56,200.00 - $101,000.00 per year At reputed company, we reputed company people to the care they need to live healthier lives — and the work you do here makes that reputed company reputed company every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making reputed company more accessible and effective. It’s work with a purpose you can see, backed by reputed company committed to improving lives reputed company reputed company the reputed company. reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company Apply To This Job