Sr Specialist, Pharmacy Claims

Includes Hybrid Work Schedule - must work close enough to commute to the Lincoln NE location 3 days per week.

Were seeking a problem-solver who enjoys tackling complex challenges investigating and resolving pharmacy claim issues and delivering exceptional service to our members. Join our Medical Claims team in Lincoln NE and make a meaningful impact by helping ensure accurate and timely claims resolution

Were proud to be named one of Lincolns Best Places to Workand were looking for people who care deeply about helping others and want to grow with a mission-driven organization.

NRECA is the national trade association representing more than 900 consumer-owned electric cooperatives across the United States. We provide advocacy financial services and business solutions that help over 900 consumer-owned electric cooperatives across the country serve their communities and we operate with integrity transparency and a spirit of innovation.

The work in the Insurance & Financial Services department (I&FS) is dynamic and intellectually challenging engaging and deeply impactful. They work to develop and administer employee benefit plans and services which are diverse and the results help improve the quality of life for hard working Americans across the country. They foster a culture that emphasizes a strong sense of diversity integrity and belonging driven by NRECAs core values like communication creative problem-solving collaboration and accountability. If youre motivated by purpose enjoy variety and care about people and outcomes this is the team for you.

As a Sr. Specialist Pharmacy Claims youll resolve pharmacy claim issues be the go-to expert for pharmacy benefit questions and escalation and identify opportunities to improve processes systems and service delivery.

The work schedule is 8:15 a.m. to 5:00 p.m. and the positioniseligible for NRECAs hybrid schedule whichallows flexibility to work from home up to 2 days per/week.

• Troubleshoot pharmacy claim issues
• Answer questions from members and providers.
• Work with internal and external partners to resolve complex benefit concerns.
• Balance investigative work with customer service while also looking for opportunities to improve processes and prevent future issues.

Required Education and Certifications:

• Associates degree in a related field (health administration pharmacy technician desired) or combination of education and experience;

• Certification in a medical terminology course or coursework in medical anatomy.

Preferred Education:

• Insurance coursework such as LOMA AHIP ICA or CEBS desired.

Required Experience:

• 7 or more years of experience with prescription claims processing for commercial insurance carriers.

• 5 years of experience working in a pharmacy; or 5 years experience with a PBM in a group insurance setting.

• Knowledge of pharmacy benefit management (PBM) including benefit design coverage limitations and formulary processes.

• Understanding of applicable regulations including HIPAA ACA Medicare Part D and other federal mandates.

• Knowledge of pharmacy and health claims operations compliance requirements and contractual plan language with the ability to interpret and apply medical technical and contractual information to claims.

• Strong analytical and critical thinking skills with the ability to identify issues evaluate information and draw sound conclusions.

• Excellent interpersonal and customer service skills.

• Effective verbal and written communication skills with the ability to interact professionally with members employees and vendors.

• Ability to exercise sound judgment discretion and decision-making in a fast-paced environment.

• Proficiency with Microsoft Office applications including Excel Word Outlook and PowerPoint.

• Ability to develop and deliver presentations training and educational sessions.

• Ability to report to the office as required

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

• Primarily sedentary work with extended periods of sitting.

• Visual acuity is sufficient for computer work and data analysis.

• Manual dexterity for frequent keyboard use.

• Occasional light lifting (up to 10 lbs).

• Effective communication in person by phone and via email.

Final Compensation determined by individual qualifications experience and internal equity.

Disclaimer Statement: The preceding job description has been written to reflect managements assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned.

Additional Requirement:

The preceding job description has been written to reflect managements assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned. All qualified applicants will receive consideration for employment without regard to race color sex sexual orientation gender identity religion national origin disability veteran status or other legally protected status.

NRECA is committed to working with and providing reasonable accommodation to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment please e-mail or call: - NRECA Arlington Human Resources. Please call - NRECA Lincoln Human Resources for Lincoln NE employment opportunities. We will make a determination on your request for reasonable accommodation on a case-by-case basis.

The U.S. Equal Employment Opportunity Commission (EEOC) recently released the Know Your Rights poster which updates and replaces the previous EEO is the Law poster and EEO Is the Law Poster Supplement.

Pay Transparency Non-Discrimination. NRECA will not discharge or in any other manner discriminate against employees or applicants because they have inquired about discussed or disclosed their own pay. Please see the Pay Transparency Nondiscrimination Provision for more information.

E-Verify. As a Federal Contractor NRECA is required to participate in the E-Verify Program to confirm eligibility to work in the United States. For information please click on the following link: E-Verify.

For more information about life at NRECA please visit .