Member Benefit Preservation Specialist

The Benefit Preservation Specialist is responsible for program solutions in order to extend the health benefits of members, including but not limited to, patient assistant program(s) for medication coverage, pharmaceutical coupon programs and ancillary claims adjudication. The Benefit Preservation Specialist also plays a key role in helping members maximize the value of their pharmacy benefits through the coordination and management of manufacturer copay card programs, patient assistance programs, and benefit preservation strategies. This individual acts as a liaison between members, providers, and internal departments to ensure financial resources are applied accurately and efficiently to support member access to medications.

Schedule: This role follows a Pacific Standard Time (PST) schedule, regardless of the employee’s physical location. Candidates may reside in other time zones but must be available to work one of the following schedules in PST hours:

• 7:30 a.m. – 4:00 p.m. HST (Monday–Friday)
• 9:00 a.m. – 5:30 p.m. HST (Monday–Friday)
• 9:30 a.m. – 6:00 p.m. HST (Monday–Friday)

Candidates must be able to work from 6:00am - 12:00pm HST for the first few weeks of training.

Duties:

• Maintain database of existing coupons and patient assistant programs involved
• Assess and identify appropriate program(s) for members based on needs
• Coordinate programs between pharmacy, members and plans as needed
• Effectively communicate between the Customer Care Department and Prior Authorization personnel for seamless and efficient member service
• Ensure compliance with all applicable laws and regulations
• Continually evaluates processes and training materials for effectiveness and efficiency of the programs
• Perform QA analysis to ensure appropriate monetary values are being applied to both claim and benefit as applicable
• Develop and document policy and procedures
• Implement new plans to the program
• Term plans as they unenroll from the program
• Assist with member communication as needed when changes to plans are made (i.e. biosimilar conversions)
• Maintain and correct member deductible and maximum out of pocket accumulators as relates to coupon programs
• Assist in other projects as assigned by management

Skills/Qualifications:

• Excellent communications skills (oral, written and interpersonal)
• Analytic skills
• Pharmacy Tech certified required
• Demonstrated ability to work well in a team environment
• Demonstrated ability to provide exceptional customer service

Education and Experience:

• High school diploma or equivalent
• 2+ years of experience in pharmacy benefit management, healthcare administration, or a related field.
• Knowledge of pharmacy claim adjudication processes and benefit plan design, a plus
• Familiarity with manufacturer copay and patient assistance programs, a plus.

About Ventegra: Ventegra is the premier, fully transparent Medical Benefits Manager (MBM) offering Pharmacy Services Administration products and services to help manage healthcare for businesses and consumers. Ventegra is committed to seeking innovative ways to channel our resources for a greater impact to improve the lives of others. Ventegra represents payors, providers, patients and government programs.

Job Type: Full-time

Pay: From $18.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance

Application Question(s):

• Are you able to work a schedule of 7:30am-4:00pm, 9:00am-5:30pm, or 9:30am-6:00pm Hawaii Standard Time?
• Are you able to work a training schedule of 6:00am-12:00pm Hawaii Standard Time ?

Experience:

• Pharmacy technician: 1 year (Preferred)
• Pharmacy Benefit: 1 year (Required)

License/Certification:

• Pharmacy Technician Certification (Preferred)

Work Location: Remote