WellDyne

Technician

• Update prescription orders under the direct supervision of the Pharmacy Supervisor (FL), following pharmacy procedures and guidelines
• Perform routine, professional pharmacy functions
• Maintain HIPAA confidentiality
• Follow and help enforce company policies and procedures
• Answer the arbiter email inbox accurately and promptly
• Manage orders in failed claims and high co-pay queues
• Verify insurance information for correct adjudication
• Check patient history for refill-too-soon issues, dose changes, and duplicate prescriptions
• Initiate prior authorizations accurately and promptly
• Perform other assigned duties

Arbiter – Failed Claims Technician

Analyst

• Provides client satisfaction through accurate benefit configuration design and set up, including consultation and collaboration with external clients, brokers and internal business partners
• Plan maintenance and benefit change requests for existing clients, including updates annually to member cost share and accumulators
• Manages the pre-assessment of benefit change requests by performing research to ensure plan configuration will meet client specifications, providing options for meeting the client intent
• Utilize the RxClaim operating system to design, build and maintain client plans and components
• End-to-end testing and validation of plans to ensure plan benefits meet client specifications
• Ability to determine and prioritize client needs to ensure all change requests meet client deadlines
• Research and provide feedback for claim-related inquiries
• Participate in external auditor reviews, including claim research
• Training current team members and any new hires
• Ability to work additional hours as workload dictates
• Additional duties as assigned

Arbiter – Failed Claims Technician

Benefit Analyst III