Specialty Operations Pharmacy Technician

Ohio, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, PharmaceuticalsIndustries

Requirements

Candidates must possess an active license with the Board of Pharmacy in the appropriate state and be PTCB certified. A minimum of 1 year of claims processing, insurance, or pharmacy experience is required, along with strong MS Office skills. Inbound/outbound call experience, customer service experience, and strong communication skills are preferred.

Responsibilities

The Specialty Operations Pharmacy Technician 2 supports pharmacists in the preparation and dispensing of Specialty Rx medications. This role involves performing varied administrative, operational, and customer support assignments, including making computations and working on semi-routine tasks. The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, processes claims for payment, and works within defined parameters to meet quality standards.

Skills

Pharmacy claims adjudication

Claims processing

Insurance

Pharmacy experience

MS Office

Reporting

Inbound/Outbound calls

Customer service

Communication skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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