Pharmacy Benefits Specialist I

Network Health WI•Menasha, WI

12d•Hybrid

About The Position

The Pharmacy Benefits Specialist I provide basic operational, planning, implementation and reporting support for the Pharmaceutical Benefits area of Network Health Plan. In addition to providing administrative support for the pharmaceutical area of Network Health, this role will build report queries and maintain operational and financial reports, research and resolve claim processing and benefit issues, act as a technical resource for internal users regarding pharmacy benefits, and maintain pharmacy formularies in written and web formats. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required) in combination with at our office in in our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday Check out our 2025 Community Report [https://www.youtube.com/watch?v=Oea3uHW0EV0] to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Requirements

High School Diploma or equivalency required
One year of experience in a Pharmacy Tech position or one year of experience working with pharmacy benefits required

Nice To Haves

Certified Pharmacy Technician preferred
One (1) year of experience working with pharmacy benefits may substitute for certification

Responsibilities

Manage large mailings including letter preparation, mail merge, and distribution
Create and maintain Prescription Benefit Summary of Member Responsibility Tables
Provide a variety of reports for internal and external stakeholders including Prior Authorization, physician utilization, Controlled Substance Reporting, Annual Quality Improvement Program Evaluation, call log and drug reports related to Key Performance Indicator Board, and working with Sales to run standard reports from Pharmacy Benefits Manager (PBM)
Complete files reviews for denials
Maintain J-Code Tier Levels billing tables for claims
Answer formulary status questions for Commercial and Medicare Sales, and Customer Service
Assist Care Management/Disease Management with benefit questions, Prior Authorization requirements, and grievances
Pull data for reporting pharmacy trends.
Manage the PBM Satisfaction Survey process
Research and resolution of benefit issues
Benefit testing
Other duties and responsibilities as assigned