Pharmacy Operations Representative - Medicaid

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Job Summary

HCSC is looking for an individual to join its Medicaid Pharmacy Operations team! This position is responsible for providing assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims. Will also work closely with internal departments and external vendors to evaluate and resolve issues; supports processes to ensure federal and state regulations and program requirements are met and maintained; and communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits.

This role requires working in the Albuquerque office at least 3 days a week and working from home up to 2 days a week. Core business hours are 8:00 AM - 5 PM MST Monday through Friday.

Job Requirements:

*Licensed and unrestricted Pharmacy Technician/Certified Pharmacy Technician (CPhT).

• Bachelor's degree in Business or a related health care field OR 4 years work experience in a pharmacy/health care/managed care industry.

• Verbal and written communication skills.

• Managed care customer service experience.

• Proficiency of MS product suite; Word, Excel, Access, and database software.

• Drug information skills.

• Handle multiple tasks and strong organizational skills.

Preferred job requirements:

• Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience.

• Telephone support to include members inquiries, providers, pharmacies, and groups regarding benefits.

• Support through written and digital channels.

• Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues.

• Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services.

*Available during core business hours Monday - Friday 8:00 AM - 5 PM MST and commute into Albuquerque, NM office.

THIS IS A FLEX/HYBRID ROLE FOR THE ALBUQUERQUE, NEW MEXICO OFFICE

This role requires working in the Albuquerque office at least 3 days a week and working from home up to 2 days a week. Core business hours are 8:00 AM - 5 PM MST, Monday through Friday .

*Must be a Current Licensed/Certified Pharmacy Technician

Experience in fast paced production environment with attention to detail is needed

#LI-Hybrid

LI-FW1

Sponsorship is not available

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$38,100.00 - $80,000.00

Exact compensation may vary based on skills, experience, and location.

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For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at View phone number on click.appcast.io to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,

Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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