Pharmacy Benefits Specialist

Job Description

Job Description

***THIS POSITION IS IN OFFICE IN SALT LAKE CITY, UT***

Professional Summary

The Pharmacy Benefit Specialist is responsible for providing high-quality customer support and accurate pharmacy claims processing within a high-volume, fast-paced environment. This role serves as a key resource for members, providers, and pharmacies by answering benefit-related inquiries, resolving claims issues, and educating callers on coverage and plan utilization. The specialist balances inbound call handling—particularly during peak periods such as open enrollment—while ensuring timely and accurate adjudication of pharmacy claims. This position also supports team development by acting as a subject matter expert and assisting with mentoring and training initiatives.

Key Responsibilities

• Handle high-volume inbound calls (approximately 40–50 per day during peak seasons) from members, providers, and pharmacies regarding pharmacy benefits, claims, and coverage questions
• Adjudicate pharmacy claims accurately and efficiently, including entering overrides and resolving processing discrepancies
• Educate callers on pharmacy benefit coverage, including coordination of benefits, coinsurance, direct member reimbursements, and mail-order prescriptions
• Research and resolve complex inquiries related to claims, billing issues, and plan utilization by reviewing account details and collaborating across departments
• Maintain compliance with department standards for call quality, productivity, documentation, and accuracy metrics
• Demonstrate strong problem-solving skills by quickly identifying issues and providing effective, customer-focused solutions
• Document all member interactions thoroughly and accurately in internal systems while ensuring confidentiality of protected health information
• Meet or exceed performance metrics, including call handle time, call volume, and quality assurance standards
• Assist with claims payment processing for members and pharmacies as assigned, ensuring adherence to accuracy and compliance standards
• Serve as a subject matter expert and provide guidance, mentorship, and support to junior team members
• Analyze and complete reports related to pharmacy claims to ensure timely processing and identify trends or discrepancies
• Collaborate with internal teams (operations, pharmacy, and customer service) to resolve issues and improve overall service delivery

Qualifications

• Minimum of 2+ years of experience in a call center environment or healthcare administrative role
• Demonstrated experience delivering high-quality customer service in a fast-paced, metrics-driven environment
• Strong verbal and written communication skills with the ability to clearly explain complex benefit information
• Proven ability to problem solve, de-escalate situations, and work effectively under pressure
• Experience handling high-volume inbound calls and managing multiple systems simultaneously
• Proficient in navigating computer systems, data entry, and multiple software applications
• Strong attention to detail with a focus on accuracy in claims processing and documentation
• Ability to maintain confidentiality and adhere to compliance standards, including HIPAA regulations
• Experience supporting or coordinating pharmacy benefits, claims adjudication, or insurance-related services is preferred

Job Type & Location

This is a Contract to Hire position based out of Salt Lake City, UT.

Pay and Benefits

The pay range for this position is $21.00 - $21.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Salt Lake City,UT.

Application Deadline

This position is anticipated to close on Sep 15, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.