Arbiter – Failed Claims Technician

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

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WellDyne

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1990

🏥 Healthcare

💊 Pharmaceuticals

⚕️ Healthcare Insurance

Healthcare • Pharmaceuticals • Healthcare Insurance

WellDyne is a pharmacy benefit management (PBM) company that provides specialty pharmacy services, prescription discount solutions, utilization management, mail-order and central fill pharmacy operations, and outsourced pharmacy solutions. The company emphasizes clinical programs, adherence initiatives, data analytics, and personalized engagement to reduce drug costs and improve outcomes, particularly for high-cost specialty medications. With about 25 years of experience and locations in Lakeland, FL and Centennial, CO, WellDyne positions itself as an alternative to traditional PBM models by offering flexible plan design, dedicated account management, and industry-focused clinical expertise.

📋 Description

• Update prescription orders under the direct supervision of the Pharmacy Supervisor (FL), following pharmacy procedures and guidelines • Perform routine, professional pharmacy functions • Maintain HIPAA confidentiality • Follow and help enforce company policies and procedures • Answer the arbiter email inbox accurately and promptly • Manage orders in failed claims and high co-pay queues • Verify insurance information for correct adjudication • Check patient history for refill-too-soon issues, dose changes, and duplicate prescriptions • Initiate prior authorizations accurately and promptly • Perform other assigned duties

🎯 Requirements

• High School Diploma or equivalent • Registered Pharmacy Technician with the State of Florida • One year minimum of pharmacy experience • Knowledge of health insurance plans • Familiarity with Microsoft Word, Excel, and Outlook • Attention to detail • Ability to handle multiple activities or interruptions at once • Ability to communicate effectively, patiently, and courteously • Ability to work with pharmacists, other departments, customers, and management • Ability to work independently with little supervision and meet daily deadlines • Ability to perform repetitious work accurately • Ability to work prolonged periods sitting and standing in front of a computer • Hand-eye coordination and manual dexterity sufficient to operate standard office and computer/phone equipment • May be required to work long hours