Role & seniority

Benefits Verification Technician (entry to mid level; requires 2+ years in a pharmacy setting)

Stack/tools

Microsoft Office; industry-related software
Pharmacy benefit management (PBM) coordination; claims adjudication knowledge

Top 3 responsibilities

Place outbound calls to providers, insurers, and patients to clarify prescriptions and billing; follow up for resolution
Process prescriptions using current insurance data and adjudication requirements
Coordinate adjudication support with PBM services; maintain records of inquiries, actions, and outcomes

Must-have skills

Excellent written and verbal communication; strong customer service
Strong organizational skills, attention to detail, time management, and ability to meet deadlines
Ability to work independently, handle confidential information, and function under pressure
Team collaboration, analytical thinking, and proficiency with Microsoft Office and relevant software

Nice-to-haves

Undergraduate degree or equivalent experience
Knowledge of claims adjudication; secondary billing (prescription discount cards, Medicaid)
Prior experience in Retail, Mail Order, Specialty Pharmacy, PBM, or managed care environments

Location & work type

Availability required: 11:30 AM–8:30 PM EST

Typical office environment; may require extended hours, weekends, and holidays as per department/industry demands
Full-time role; duties include training/support and process updates across the departme

Full Description

Position Summary

The Benefits Verification Technician is responsible for providing assistance to members, insurance carriers, and providers with inquiries for member’s eligibility for claims processing. Assists with questions and correspondence to find resolution to all problems with a patient’s prescription. Availability of 11:30 AM - 8:30 PM EST required.

Essential Duties/Responsibilities

Place outbound phone calls regarding pharmacy prescriptions to providers, insurance carriers and patients to obtain prescription and/or billing clarification; follow-up as needed for resolution.

Contact members to obtain information or to advise of a delay in order processing.

Coordinate adjudication support with pharmacy benefit management (PBM) services.

Process prescriptions using current insurance data and requirements for adjudication.

Proper handling of routine inquiries from members, providers, pharmacies, and payers

Maintain record of correspondence, recording details of inquiries, complaints, comments as well as actions taken

Coordinate with pharmacist to resolve member prescription issues as needed.

Organize and maintain reference sheets for the team as changes with insurance payers occur.

Assist with training and updates within the department of technicians as needed.

Assist customer service and other departments with various tasks, including member correspondence, as needed.

Assist supervisor with updates or changes in processes and procedures within the department, including keeping up with changes in adjudication standards and requirements.

Assist in prescription/business audits for third party payers.

Achieve individual performance goals for productivity and quality.

Advise supervisor(s) of escalated issues.

Performs other duties as assigned.

Required Skills/Abilities

Excellent verbal and written communication skills.

Excellent interpersonal and customer service skills.

Excellent organizational skills and attention to detail.

Excellent time management skills with a proven ability to meet deadlines, prioritize work and work independently.

Ability to exercise considerable judgment, maintain confidentiality, and act in a diplomatic manner.

Ability to collaborate with peers in a team effort.

Strong analytical and critical thinking skills.

Ability to function well in a high-paced and at times stressful environment.

Proficient in Microsoft Office and industry related software programs

Ability to work extended hours, weekends, and holidays in alignment with departmental and industry demands

Education/Experience

High School Diploma required, Undergraduate degree desired or equivalent work experience.

Current Pharmacy Technician with National Certification OR Registered Pharmacy Technician Status with applicable State Board of Pharmacy

At least 2+ years in Pharmacy setting. Prior experience in Retail, Mail Order of Specialty Pharmacy, PBM, pharmaceutical or managed health care industry preferred.

Knowledge of claims adjudication preferred.

Knowledge of secondary billing practices including prescription discount cards and Medicaid preferred.

Work Environment/Physical Requirements

Typical office environment, with minimal exposure to excessive noise or adverse environmental issues.

Prolonged periods of sitting, standing, walking, and working on a computer.

Ability to bend, reach, stoop, kneel.

Ability to utilize visual acuity to operate equipment and read technical information.

Ability to lift 15 pounds at times.