Become a part of our caring community and help us put health first
 

The Specialty Operations Pharmacy Technician 2 adjudicates pharmacy claims and process pharmacy claims for payment. Performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

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. 

Use your skills to make an impact
 

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

40

Pay Range

The compensation range below reflec