The Specialty Operations Pharmacy Technician 2 (Claims Adjudication) will be responsible for the following:
Analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.
Operate under minimal direction with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high-quality patient care and operational excellence.
Following standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Research and interpret insurance claims, while utilizing a broad array of clinical and informational resources to obtain pertinent information.
$1,500 Sign-On Bonus ($750 upon hire and a second $750 payment after completing 6 months (180 days) of employment)
Required Qualifications
Must have an active license with the Board of Pharmacy in the state of residence (Ohio, Florida or Arizona)
Must be certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification
Must be able to research, read & interpret clinical information
Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions and deliver the highest quality customer experience
Problem solver who can find viable solutions that meets member/customer needs, absent from all ideal tools and resources
Excellent communication skills (verbal and written)
Experience using multiple computer applications simultaneously and strong data entry skills
Preferred Qualifications
Experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting
Mail Order Pharmacy or Specialty Pharmacy experience
Experience working with insurance plans and Medicare
Experience submitting and/or reading pharmacy claims, particularly in RxNova
Experience with Scriptmed
Previous experience with pharmacy benefits management
Claims experience
Additional Information
Hours: The preferred hours of operation for this position will be an 8-hour shift within the hours 9 a.m.-5:30 p.m. in your reflective time zone
Overtime: When there is a business need, overtime will be requested. Potentially voluntary or mandatory.
Holidays: When there is a business need to work on a holiday outside of Thanksgiving day and Christmas Day, there is the possibility of working on a holiday.
Work Style: Remote
Work at Home/Remote Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
HireVue Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.