WHO YOU ARE:

• Pharmacy Technician or related experience highly desirable
• 1-3 years of PBM experience in claims or benefit configuration

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:
1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
4) We cultivate grit
Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is Proudly an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance

ABOUT THE ROLE:

The PBM Operations Coordinator is a member of the Rightway Data Operations team reporting to the Manager of Data Operations. This role will be responsible for the day to day inquiries and operations related to data operations, specifically focusing on eligibility and accumulator dat

WHAT YOU’LL DO:

• Primary Contact: Serve as the main point of contact for all internal inquiries related to eligibility and accumulator data, ensuring timely and accurate resolution.
• Troubleshooting: Research and troubleshoot inquiries or issues related to accumulator and eligibility data. This includes reviewing incoming eligibility or accumulator files to troubleshoot the issue.
• Data Management: Identify and address missing accumulator data; update and maintain eligibility records as needed.
• Reporting: Generate and analyze member-level accumulator reports to monitor and ensure data accuracy.
• Collaboration: Work closely with various departments, including Account Management, the Contact Center, and the Benefits Team, to resolve member-specific issues and address or escalate broader client concerns.
• Assistance: Support the PBM Pharmacy Associate with daily error reports concerning eligibility and accumulator data. Also support daily tracking of inbound accumulators and eligibility files.
• Vendor Communication: Liaise with eligibility and accumulator vendors to resolve any member-related issues.
• Complex Issue Resolution: Partner with the PBM Pharmacy Associate to address and resolve complex data-related issues.
• Documentation: Ensure that all documentation regarding system setups and implementations is current and accurate