[Hiring] Customer Care Pharmacy Support Specialist @WellDyne

Role Description

The Customer Care Pharmacy Support Specialist is a Customer Care position responsible for supporting partner clients, patients, and providers with pharmacy and prescription claim inquiries. This role combines inbound contact center expertise with pharmacy technician knowledge and the ability to research, troubleshoot, and reprocess pharmacy claims for authorized partner clients. The position serves as a subject matter expert and analytical resource within Customer Care while collaborating with the Pharmacy, Client Services, and Operations. Success in this role is demonstrated through accurate claim resolution, quality customer experiences, appropriate claim reprocessing, and adherence to client, regulatory, and organizational requirements. This position reports to the Manager or Supervisor, Customer Care.

Essential Duties and Responsibilities

• Provide advanced support for complex patient, pharmacy, provider, and client inquiries across supported lines of business.
• Validate claim information, eligibility, benefit requirements, and other applicable information before initiating an authorized claim reprocessing transaction.
• Reprocess pharmacy claims for authorized partner clients in accordance with client-specific requirements, approved procedures, assigned system permissions, and applicable regulatory requirements.
• Serve as a subject matter expert and escalation resource for Customer Care Advocates regarding pharmacy benefits, claims, systems, and client-specific processes.
• Follow up with patients as needed to ensure medication orders are processed.
• Support patients, providers, and members with pharmacy mail order coordination.
• Handle sensitive and escalated customer interactions requiring advanced research, judgment, and problem-solving.
• Perform authorized pharmacy technician functions within applicable laws, regulations, organizational procedures, and the defined scope of the position.
• Ensure compliance with HIPAA, applicable pharmacy requirements, client requirements, and organizational policies.
• Perform additional duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Active Pharmacy Technician registration, license, or certification required.
• Certified Pharmacy Technician (CPhT) credential preferred.
• 1-2 years pharmacy/customer service experience preferred.
• Experience processing or reprocessing pharmacy benefit claims strongly preferred.

Knowledge, Skills and Abilities

• Experience processing or reprocessing pharmacy benefit claims strongly preferred.
• Ability to reprocess pharmacy claims accurately within assigned system permissions and established procedures.
• Strong analytical, troubleshooting, critical-thinking, and problem-solving skills.
• Ability to distinguish issues that can be resolved operationally from those requiring pharmacist, clinical, configuration, compliance, or leadership intervention.
• Ability to work independently and collaboratively in a fast-paced Customer Care environment.
• Ability to maintain confidentiality and handle sensitive information with integrity.

Work Environment / Physical Demands

• This position is in a typical office environment which requires prolonged sitting in front of a computer.
• Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.
• May have occasional high stress when dealing with customers/clients.
• Some travel may be required.

Company Description