Pharmacy Operations Support Specialist

Lumeris

Pharmacy Operations Support Specialist assisting in claims management and prior authorizations in Medicare Part D. Supporting customer service and compliance efforts while ensuring timely member access to prescription drugs.

Posted 5/15/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $39,000 - $48,150 per yearWebsite

About the role

Key responsibilities & impact

Reviews rejected pharmacy claims for appropriateness.
Becomes a pharmacy claims processing subject matter expert and triages claims issues.
Becomes subject expert with Medicare Part D policies and procedures.
Reviews transition claims reports.
Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
Supports medical pharmacy prior authorizations and Medicare Part D drug reconsiderations.
Supports Medicare Part D call center questions and issues received from members, pharmacies, and providers.
Supports compliance functions and requests.
Supports quality programs including STARS.
Conducts retrospective claims reviews.
Complies, interprets, documents, and tracks findings from claims monitoring data.

Requirements

What you’ll need

High school diploma, GED, or equivalent
Current Certified Pharmacy Technician License in good standing
1+ years Pharmacy Technician or retail pharmacy experience or the knowledge, skills, and abilities to succeed in the role
Flexible with the ability to consistently meet deadlines and adapt to a changing work environment
Strong planning, time management, and organizational skills
Team player with a positive attitude
Strong professional verbal and written communication skills
Basic PC skills, including Microsoft Excel, Word, and Outlook
Preferred 2+ years of experience in retail pharmacy
Preferred 2+ years of Pharmacy Technician experience
Part D health plan or pharmacy benefit management experience

Benefits

Comp & perks

Medical, Vision and Dental Plans
Tax-Advantage Savings Accounts (FSA & HSA)
Life Insurance and Disability Insurance
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
Employee Assistance Program
401k with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
And much more...

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

pharmacy claims processingMedicare Part D policiesprior authorizationsclaims monitoringretrospective claims reviews

Soft Skills

planningtime managementorganizational skillsteam playerverbal communicationwritten communicationflexibilityadaptability

Certifications

Certified Pharmacy Technician License