Humana Pharmacy Claim Audit and Review | Pharmacy Specialist in Louisville, Kentucky

Role: Pharmacy Specialist

Assignment: Pharmacy

Location:Louisville, KY

Bring your unique talents and perspectives to Humana and help us bring better healthcare solutions to our members. At Humana, you’ll have the opportunity to interact with members, provide professional advice, and enable positive outcomes in a growing organization. Humana’s innovative approach to mail-order pharmacy solutions enables us to outpace the competition, with the well-being of our members in mind. Our innovative Pharmacy Solutions offers a cost-effective, easy way for our members to receive their medications without waiting in line, and giving them back more time in their days to enjoy life. We’re looking for people from a variety of healthcare backgrounds to join our growing pharmacy team and work with people at all levels of the industry. At Humana, you’ll partner with people who care.

Assignment Capsule

Be a part of the Pharmacy world – providing perfect service to members in a growing Pharmacy environment.

Humana is seeking a Pharmacy Specialist to collects and enter information required for timely and accurate processing of prescription orders for our members.

As an outreach associate, you will: perform outreach to pharmacies and prescribers to attempt to resolve a rejected pharmacy claim using a variety of tools. * Research and investigate assigned claim rejections due to various DST edits

  • Contact pharmacies and prescribers through telephone, email or fax to confirm claim appropriateness and resolve errors through education on Humana’s products and services (when applicable)

  • Document pertinent information regarding pharmacy/prescriber behavior to enhance existing outreach process and develop process improvement proposals

  • Identify pharmacy and error code trends throughout outreach and collaborate with team members as well as key business areas to identify potential POS processing issues, determine root cause, and escalate to leadership for resolution

Key Competencies

  • Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.

  • Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.

  • Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.

  • Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.

  • Build Trust: You honor your word by doing what you say you are going to do.

  • Champions the Customer: You keep closely attuned to the needs and perspectives of customers and use this insight for the benefit of the business.

  • Drives for excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.

  • Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.

Role Essentials Candidates for this position must have the following skills: * High School Diploma or equivalent

  • Effective communication skills are a must

  • Certified Pharmacy Technician

  • Previous call center or related customer service experience

  • Proficiency in all Microsoft Office Programs, including Excel, Access, Visio

  • Capacity to maintain confidentiality and professionalism Role Desirables

  • Experience in mail order and/or retail pharmacy setting

  • Associate Degree or Bachelor Degree

  • Working knowledge of DST and RxIntel

  • Experience using Humana's systems including but not limited to CCP2, CAS,MTV, PAHub, EDW Reporting Relationship You will report to a Process Manager.

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.

Title: Pharmacy Claim Audit and Review | Pharmacy Specialist

Location: KY-Louisville

Other Locations: US-KY-Louisville

Requisition ID: 190504

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.