Pharmacy Technician, Member Services

🔥 1 hour ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $46k - $52k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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Curative

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2020

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

Curative is an employer-focused health insurance company offering a next-generation group health plan that emphasizes affordability, engagement, and simplicity. Their plans promise $0 in-network copays, $0 deductibles, and a single competitive monthly premium, along with a broad provider network, telehealth, an extensive $0-preferred prescription formulary, care navigators, and the Curative Cash Card to eliminate out-of-pocket costs in many settings. Curative markets to employers and brokers while providing members with resources like a Baseline Visit, care programs, online portals, and pharmacy services, and holds an A- rating from AM Best and HITRUST r2 certification.

📋 Description

• Monitor prescription claim rejections from third-party pharmacies • Contact members and providers regarding rejections and offer alternative options when applicable • Discuss prior authorization decisions with members and providers • Evaluate extenuating requests and process overrides in the CAPRx JUDI system • Coordinate non-formulary drug alternatives and notify members and providers • Contact third-party pharmacies to reprocess claims and communicate drug alternatives and prior authorization status • Correct claims and prior authorization requests as needed • Serve as subject matter expert on pharmacy and drug benefits • Handle escalated contacts from members, providers, pharmacies, and the member services team • Provide after-hours escalation support for issue resolution as needed • Process notifications to the member services team for outreach and prescription-status updates • Collaborate with leadership on policy and process improvements • Perform other assigned duties, project management, and data reporting • Follow US regulatory and Quality System requirements, including 21 CFR 820 • Attend mandatory remote training and complete competency and retention exams

🎯 Requirements

• Minimum 5 years experience in pharmacy or PBM operations • Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience • Active PTCB certification required • Excellent attendance is critical to success in this position • Excellent computer and phone skills, attention to detail, process and policy adherence • Call Center Experience preferred but not required • Excellent verbal and written communication skills • Strong interpersonal skills • Active listening skills to accurately respond to inquiries and requests • Exceptional organizational skills; retention of policy and process required • Intermediate skills minimum in Google and Microsoft Office Suite products • Experience with Talkdesk or other VOIP phone systems preferred but not required • Experience with Helpscout or other email ticket systems preferred but not required • Experience with JUDI or other prescription claims systems preferred but not required • Experience with Slack, Gmail, and Zoom Conference preferred but not required • Must have a quiet, secure, distraction-free work-from-home location • Must have password-protected, stable internet access • Work location must be secure and private to maintain HIPAA compliance • Must attend the full mandatory remote training program and pass daily competency exams and retention exams with grades of 90% or above • Travel expected: 0%

🏖️ Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.) • $0 copays and $0 deductibles (with completion of our Baseline Visit) • Preventive and primary care built in • Mental health support • One-on-one care navigation • Chronic condition programs (diabetes, weight, hypertension) • Maternity and family planning support • 24/7/365 Curative Telehealth • Pharmacy benefits • Comprehensive dental and vision coverage • Employer-provided life and disability coverage with additional supplemental options • Flexible spending accounts • Generous PTO policy plus 11 paid annual company holidays • 401K for employees • Generous Up to 8–12 weeks paid parental leave, based on role eligibility. • Password-protected, stable internet access stipend • Office equipment supplied including PC, monitor, keyboard, mouse, and headset • 2–3 week minimum remote training program

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