Our Pharmacy Technicians provide support for the clinical, operational, and quality functions of Bright Health’s pharmacy department. This position’s primary role is to develop a detailed understanding of benefit and formulary configuration which will be used to identify potential discrepancies with claims processing, assist with quality reviews for pharmacy coverage determinations, and to help resolve inquiries by members and stakeholders.

ROLE RESPONSIBILITIES

• Perform pharmacy claims review for Bright Health and affiliate plans to ensure appropriate claims adjudication and the related accuracy of current plan year benefit and formulary configuration.
• Perform pharmacy coverage determination reviews for Bright Health and affiliate plans to ensure cases were reviewed appropriately and timely.
• Assist with testing and validation of new plan year pharmacy benefit installation for Bright Health and affiliate plans within PBM (Pharmacy Benefit Manager) testing and production systems.
• Assist with resolving inquires, issues, and audits that may come from members, providers, and internal stakeholders.
• Provide outreach to members, providers, and pharmacies to assist in claim or authorization resolution.
• Contribute to the preparation of dashboards and reports that will be used for oversight, management, and leadership reporting for Bright Health and affiliate plans.
• Collaboratively work with both clinical and non-clinical areas within Bright Health and affiliate plans.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree preferred.
• Five (5) years’ experience in the pharmacy industry required.
• Successful completion of a Certified Pharmacy Technician Course and certification exam (state or national) is required.
• Knowledge and experience with Medicare Part D preferred
• Knowledge and experience working with a PBM preferred.

PROFESSIONAL COMPETENCIES

• Strong writing and verbal communication skills.
• Proficient in simplifying complex clinical information into tactical solutions that reduce pharmacy costs and promote quality measures.
• Previous call center experience
• Comfortable following timeline driven workplans and managing multiple projects.
• Strong operational mindset and ability to use data to draw insights.
• Must thrive in collaborative environments.

LICENSURES AND CERTIFICATIONS

• Active and unrestricted Pharmacy Technician license nationally or in any US state is required.

WORK ENVIRONMENT

• Remote

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $25.56-$38.34 Hourly.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.