adjudication specialist

National Security Agency

<div><div>Security and Counterintelligence is responsible for the protection of NSA/CSS information, people and facilities worldwide. In support of this mission, Adjudicators are responsible for ensuring a trusted workforce by providing timely and efficient decisions to determine an individual's eligibility for initial or continued access to NSA classified information, to include evaluating candidates sponsored by the military or external agencies for access to NSA operational areas. Adjudicators work in a myriad of offices within Security and Counterintelligence and their responsibilities include, but are not limited to:
- Conducting security adjudicative administrative processes
- Conducting the security adjudicative analytic and risk mitigation process
- Coordinating the security clearance process, including vetting, approval, denial, and access control
- Making security clearance determinations in accordance with DOD, IC, and NSA/CSS personnel security regulations, principles, and processes
- Evaluating reports of investigations, interpreting, and applying adjudicative guidelines to formulate a recommended course of action consistent with relevant Executive Orders, OPM, Department of Justice, and NSA related to security/suitability determinations
- Corroborating or mitigating serious derogatory information
- Reviewing case files of all relevant materials pertaining to a case including all paperwork, any other source materials, and the opinions of other relevant/investigative personnel
- Reviewing investigative documents to identify discrepancies, inconsistencies, and areas potentially requiring clarification or additional investigation
- Reviewing internal records to determine if there are any open internal cases which may be related to affiliate's background investigation
- Determining if additional inquiries are necessary to resolve discrepant, negative, or contradictory information
- Retrieving data from credit bureaus, requesting Local Agency checks, reviewing reports to determine criminal records or traffic violations
- Reviewing adjudicative determinations of other personnel security professionals (e.g., polygraphers, security information specialists, counterintelligence investigators)
- Reviewing and verifying information submitted on applications/Personnel Security Questionnaires</div><div>
Job Summary
Adjudicators ensure a trusted workforce by providing timely and efficient decisions to determine an individual's eligibility for initial or continued access to NSA classified information. Decisions are based on information developed through Reports of Polygraph Examination, Reports of Investigation, continuous evaluation programs and various other investigative/analytical resources per the criteria established in Intelligence Community Directive 704 (ICD 704).</div><div>
Qualifications
The qualifications listed are the minimum acceptable to be considered for the position.
Degree in any field is acceptable.
Relevant experience must be in one or more of the following: adjudication, personnel security, physical security, counterintelligence, anti-terrorism force protection, analysis, investigation, or auditing.
ENTRY/DEVELOPMENTAL
Entry is with a high school diploma or GED plus 4 years of relevant experience, or an Associate's degree plus 2 years of relevant experience, or a Bachelor's degree and no experience.
FULL PERFORMANCE
Entry is with a high school diploma or GED plus 7 years of relevant experience, or an Associate's degree plus 5 years of relevant experience, or a Bachelor's degree plus 3 years of relevant experience, or a Master's degree plus 1 year of relevant experience, or a Doctoral degree and no experience.</div><div>
Competencies
The ideal candidate has a desire for continual learning with excellent problem-solving, analytic, and interpersonal skills who is:
- A strong written and oral communicator
- Able to work as an individual and in team environment
- Capable of making independent decisions or recommendations
- Well-organized, able to handle multiple assignments and prioritize work
- Focused on customer needs
- Able to use basic office tools and functions, such as Microsoft Products (Word, Excel, Outlook)
- Able to lift 20lbs
- Preference is given to applicants with a DoD Adjudicator Professional Certification (APC)</div><div>
Pay, Benefits, &amp; Work Schedule
Pay: Salary offers are based on candidates' education level and years of experience relevant to the position and also take into account information provided by the hiring manager/organization regarding the work level for the position.
Salary Range: $57,736 - $133,142 (Entry/Developmental, Full Performance)
Salary range varies by location, work level, and relevant experience to the position.
Training will be provided based on the selectee's needs and experience.
Benefits: NSA offers a comprehensive benefits package.
Work Schedule: This is a full-time position, Monday - Friday, with basic 8hr/day work requirement between 6:00 a.m. and 6:00 p.m. (flexible). Core hours are 10:00 a.m. to 2:00 p.m..
DCIPS Trial Period:
If selected for this position, you will be required to serve a two-year DCIPS trial period, unless you are a veterans' preference-eligible employee, in which case you are required to serve a one-year trial period. This trial period runs concurrently with your commitment to the position, if applicable. Before finalizing your appointment at the conclusion of your trial period, NSA will determine whether your continued employment advances the public interest. This decision will be based on factors such as your performance and conduct; the Agency's needs and interests; whether your continued employment would advance the Agency's organizational goals; and whether your continued employment would advance the efficiency of the Federal service.
Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
If you do not receive certification for continued employment, you should receive written notice prior to the end of your trial period that your employment will be terminated and the effective date of such termination.</div><div>
How to apply
Apply soonest, as job postings can close earlier than stated end dates due to changes in requirements. It is important to review and note the minimum qualifications, as only those applicants who meet the required qualifications will be contacted to continue the employment process. Please populate the resume tool to showcase any relevant work experience and education related to the position and answer any applicable screening questions. Information collected will be used to determine eligibility, and failure to provide accurate information may result in disqualification for this position.
A confirmation email will be sent after submission of the first application and also after any future updates to submitted applications. **Due to time sensitive communications regarding applications, please ensure your spam filters are configured to accept email from noreply@intelligencecareers.gov. For job vacancies that include stated testing requirements, also include the following: @uwe.nsa.gov, @nsa.gov, and @pearson.com**
U.S. Citizenship is required for all applicants. NSA is an equal opportunity employer and abides by applicable employment laws and regulations. All applicants and employees are subject to random drug testing in accordance with Executive Order 12564. Employment is contingent upon successful completion of a security background investigation and polygraph. NSA is committed to providing reasonable accommodations to qualified applicants with disabilities during the application and hiring process. 
The following four narrative questions provide an opportunity for you to highlight your dedication to public service for the hiring manager and agency leadership (or designee(s)). While your responses are not required and will not be scored, we encourage you to thoughtfully address each question. Please provide a response of 200 words or less to each question. You will be asked to certify that you are using your own words and did not use a consultant or artificial intelligence (AI) such as a large language model (LLM) like ChatGPT or Copilot. (Please attach in application)
1. How has your commitment to the Constitution and the founding principles of the United States inspired you to pursue this role within the Federal government? Provide a concrete example from professional, academic, or personal experience.
2. In this role, how would you use your skills and experience to improve government efficiency and effectiveness? Provide specific examples where you improved processes, reduced costs, or improved outcomes.
3. How would you help advance the President's Executive Orders and policy priorities in this role? Identify one or two relevant Executive Orders or policy initiatives that are significant to you, and explain how you would help implement them if hired.
4. How has a strong work ethic contributed to your professional, academic or personal achievements? Provide one or two specific examples, and explain how those qualities would enable you to serve effectively in this position.</div><div>
DCIPS Disclaimer
**VETERANS AND TRANSITIONING SERVICE MEMBERS**
Thank you for your service! The National Security Agency (NSA) is part of the Defense Civilian Intelligence Personnel System (DCIPS). All positions at NSA are in the Excepted Service under Title 10, United States Codes (U.S.C.), Section 1601 appointment authority.
Veterans' Preference
In accordance with the procedures provided in DoD Instruction 1400.25, Volume 2005, &quot;DoD Civilian Personnel Management System: Defense Civilian Intelligence Personnel System Employment and Placement,&quot; NSA applies veterans' preference, as defined by Section 2108 of Title 5, U.S.C., to eligible candidates. If you are claiming veterans' preference, you are required to provide acceptable documentation of your preference eligibility upon application.
Acceptable documentation includes:
- DD-214: &quot;Certificate of Release or Discharge from Active Duty,&quot; which shows dates of service and discharge under honorable conditions (Copy 4); OR
- Certification of Service:
A written document on letterhead from the appropriate branch of the armed forces that certifies the service member is expected to be discharged or released from active duty service in the armed forces under honorable conditions not later than 120 days after the date the certification is signed. The certification should include the military service dates, including the expected discharge or release date; AND
- Standard Form 15 (SF-15)
Application for 10-point Veteran Preference (http://www.opm.gov/forms/pdf_fill/sf15.pdf).
If you are claiming a service-connected disability of 30 percent or more, the documentation you provide must specifically demonstrate this level of disability; AND
- VA Letter of Disability (for 10pt and Sole Survivorship rating)
You may obtain a letter from the Department of Veterans Affairs reflecting your level of disability for preference eligibility by visiting a VA Regional Office, contacting a VA call center, or online (https://www.ebenefits.va.gov/).
**Failure to provide sufficient documentation of veterans' preference eligibility may preclude NSA from identifying you as a preference eligible candidate during the hiring selection process.</div></div><div></div>

Adjudicator

Oak Harbor Freight Lines

Auto & Property Claims Specialist I
 
Oak Harbor Freight Lines is an established, successful regional trucking company operating in Washington, Oregon, Idaho, Nevada, Utah, Arizona, and California. As a premier carrier offering superior service, we are always interested in exceptional people with excellent skills who strive to achieve their best. We are searching for an energetic and upbeat individual to join our team as an Auto & Property Claims Specialist I.
 
The Auto & Property Claims Specialist I will be responsible for overseeing and managing driver and accident claims from initial report through resolution. This position involves a dynamic combination of managing driver incidents, accident claims, and identifying subrogation opportunities. A successful candidate will thrive in an environment that requires multitasking, investigation, information gathering, and detailed record keeping—often moving multiple claims forward simultaneously.
 
Duties include reviewing police reports, gathering photos and documentation, and preparing key
 materials for the review board’s determination. This position will work closely with the shop
 managers, operations leaders, and the Human Resources and Safety departments.
 
Essential Duties and Responsibilities: 
<ul>
<li>Manage and process accident claims from start to finish</li>
<li>Collect and process internal accident reports, including ensuring the preventable/non-preventable ruling is made timely and sent to the Terminal Manager for handling.</li>
<li>Coordinate with multiple departments to gather required documents</li>
<li>Document conversations and e-mail correspondence</li>
<li>Follow up on opening activities</li>
<li>Check claims for validity and accuracy</li>
<li>Identify and pursue subrogation opportunities, including gathering supporting documentation and coordinating recovery efforts</li>
<li>Perform other duties as assigned.</li>
</ul>
Skills, Experience, and Educational Requirements
 <ul>
<li>High School diploma/GED equivalent or higher</li>
<li>Claims or insurance experience preferred, but not required</li>
<li>Effective analytical skills to gather information, analyze facts, and make recommendations based on information collected.</li>
<li>Strong oral and written communication skills, with the ability to convey information clearly and concisely</li>
<li>Excellent time management and organizational skills</li>
<li>Strong PC skills, including Microsoft Office</li>
<li>Multi-task ability as well as detail-oriented</li>
<li>Customer service-focused</li>
<li>Ability to work independently with minimal supervision as well as collaboratively in a team environment</li>
<li>Basic English language proficiency (reading, writing, and verbal) is required.</li>
</ul>
Benefits
 <ul>
<li>Medical, dental, vision – You choose which plan suits you and our family.</li>
<li>Employee only pays 0% up to 2% of gross income.</li>
<li>Family pays 0% up to 4% of gross income.</li>
<li>401K – 100% match up to 5% of employee's contribution.</li>
<li>Accrue 80 hours of PTO within the first 11 months and 120 in your second year.</li>
<li>Holiday pay after your 90 days.</li>
<li>Company Paid Life Insurance.</li>
</ul>
http://www.oakharborbenefits.com/full-time-regular-employees.html
 Oak Harbor Freight Lines is an Equal Opportunity Employer

Auto & Property Claims Specialist

Philadelphia Insurance Companies

<div>Description
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We a re looking for a Claims Specialist - Auto to join our team!
JOB SUMMARY 
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES 
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. 
Communicates with all relevant parties and documents communication as well as results of investigation. 
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. 
Travel is required to attend customer service calls, mediations, and other legal proceedings. 
JOB REQUIREMENTS 
High School Diploma; Bachelor's degree from a four-year college or university preferred. 
10 plus years related experience and/or training; or equivalent combination of education and experience.<ul><li>National Range : $82,800.00 - $97,300.00</li><li>Ultimate salary offered will be based on factors such as applicant experience and geographic location.</li></ul>
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. 
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at https://www.phly.com/Careers/default.aspx</div>

Claims Specialist - Auto

Mercor

<div>
 
 About The Job
 
 
 
 
 Mercor
 
 connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include
 
 Benchmark
 
 ,
 
 General Catalyst
 
 ,
 
 Peter Thiel
 
 ,
 
 Adam D'Angelo
 
 ,
 
 Larry Summers
 
 , and
 
 Jack Dorsey
 
 .
 
 
 
 Position:
 
 Claims Operations Expert
 
 
 
 Type:
 
 
 Contract
 
 
 
 
 Compensation:
 
 
 $55&ndash;$80/hour
 
 
 
 
 Location:
 
 
 Remote
 
 
 
 
 Role Responsibilities
 
 
 
 <ul>
 <li>
 Develop long-horizon claims tasks with deterministic rubrics to evaluate agent performance against verifiable ground truth.
 </li>
 <li>
 Build scenarios in FNOL and triage, Adjudication, and Specialized handling to ensure tasks have checkable answers.
 </li>
 <li>
 Evaluate FNOL and triage processes, including intake against required-field checklists and coverage analysis with documented determinations.
 </li>
 <li>
 Review adjudication tasks such as reserve setting against guidelines and adjuster notes with required elements.
 </li>
 <li>
 Collaborate on specialized handling scenarios like subrogation screening and SIU fraud referrals using rule-based criteria.
 </li>
 <li>
 Work independently and asynchronously to meet deadlines while improving AI model performance.
 
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Must-Have
 
 
 
 <ul>
 <li>
 3+ years as a claims adjuster, claims operations specialist, or claims supervisor in P&amp;C, workers comp, or specialty lines.
 </li>
 <li>
 Expertise in specific claim types, coverage analysis, reserving practice, subrogation, SIU or fraud investigation, or claims systems like Guidewire ClaimCenter or Duck Creek.
 </li>
 <li>
 Comfortable with claims artifacts: FNOLs, coverage opinions, reserve memos, adjuster notes, settlement, and denial letters.
 </li>
 <li>
 Clear written communication; ability to articulate reasoning step by step and encode it into deterministic rubrics.
 
 
 
 </li>
 </ul>
 
 Preferred
 
 
 
 <ul>
 <li>
 Adjuster licensure in at least one US state.
 
 
 
 </li>
 </ul>
 
 Compensation &amp; Legal
 
 
 
 <ul>
 <li>
 Hourly contractor
 </li>
 <li>
 Strong contributors promoted based on task quality and throughput.
 
 
 
 </li>
 </ul>
 
 Application Process (Takes 20&ndash;30 mins to complete)
 
 
 
 <ul>
 <li>
 Upload resume
 </li>
 <li>
 AI interview based on your resume
 </li>
 <li>
 Submit form
 
 
 
 </li>
 </ul>
 
 Resources &amp; Support
 
 
 
 <ul>
 <li>
 For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
 </li>
 <li>
 For any help or support, reach out to: support@mercor.com
 
 
 
 </li>
 </ul>
 
 PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
 
</div>

Claims Adjuster | Upto $80/hr Part-time

ECP, Inc.

Automotive Claims Specialist (Appraisal &amp; Appearance Protection)Job Description: ECP Incorporated is currently seeking a detail-oriented Automotive Claims Specialist, preferably with technical appraisal experience. We are searching for a representative capable of defining problems and collecting data, specifically regarding appearance protection claims (Paint, Windshield, and Interior).The ideal candidate has a background in automotive damage estimation and a strong understanding of repair software and consumer correspondence. This is a professional office-based role focused on technical adjudication rather than retail service writing.Summary: Responsible for adjudicating appearance protection warranty claims by corresponding with customers, body shops, and glass/upholstery technicians.Essential Duties and Responsibilities:<ul><li>Receives and processes appearance claims (Paint, Fabric/Leather, and Windshield) from customers.</li><li>Sets up digital files and maintains detailed technical notes on claim progression.</li><li>Reviews and audits damage estimates using CCC ONE or similar appraisal platforms to ensure repair accuracy.</li><li>Corresponds with customers, vendors, body shops, and PDR (Paintless Dent Repair) technicians regarding claim status and coverage.</li><li>Negotiates labor rates and service costs with providers to ensure the most cost-effective remedy is utilized.</li><li>Coordinates with inspection centers and appraisers on complex or problem claims.</li><li>Initiates professional approval and denial letters based on contract specificities.</li><li>Inputs claim check requests for administrative approval.</li><li>Interacts professionally and courteously with customers.</li></ul>Education and Experience:<ul><li>1-4 years of related experience in automotive damage appraisal, body shop estimating, or claims adjudication.</li><li>Proficiency in CCC ONE is highly preferred.</li><li>Equivalent combinations of education and technical field experience will be considered.</li></ul>Benefits: ECP offers competitive Benefits: Comprehensive Health Insurance Coverage, Dental, Vision, Life Insurance, 401(k) Matching, and Paid Time off.About ECP: Since 1969, ECP Brands have been seen on over 45 million vehicles. Over 14 thousand automobile dealers and carwash operators use ECP products, programs and services. Our heritage has been in the manufacturing, packaging and distribution of protective coatings, detailing, prep, carwash and service chemicals and supplies, and in providing the administration of product warranties and financial services programs to produce aftermarket sales opportunities and cost savings for automobile dealers and related businesses.ECP is proud to be an Equal Opportunity Employer. All employees and applicants will receive consideration for employment without regard to age, color, disability, gender, national origin, race, religion, sexual orientation, gender identity, protected veteran status, or any other classification protected by federal, state, or local law. ECP participates in the E-Verify process for all new hires.Job Type: Full-timePay: $45,000.00 - $55,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>Automotive claims : 1 year (Preferred)</li><li>Customer Service: 1 year (Preferred)</li></ul>Work Location: In person

Automotive Claims Representative I

Shields Health Solutions

<div><div><h1 class="jobSectionHeader">Patient Engagement Specialist (Remote)</h1>

 Location: Remote (U.S.)
<h2 class="jobSectionHeader">
Make a Direct Impact on Patient Care&mdash;From Home</h2>

Are you a certified pharmacy technician passionate about patient support, medication access, and high-quality service? As a Patient Engagement Specialist, you'll serve as a critical connection between patients, pharmacists, clinicians, and health system partners&mdash;ensuring timely medication refills, resolving pharmacy claims, and delivering compassionate support across the care continuum.

This is a remote pharmacy role ideal for professionals who thrive in a fast-paced, patient-centered environment and enjoy proactive outreach and problem-solving.

<h2 class="jobSectionHeader">What You'll Do</h2>

In this role, you will manage both inbound and outbound pharmacy communications while supporting medication access and adherence.
<h3 class="jobSectionHeader">
Core Responsibilities</h3>
<ul><li> Handle inbound pharmacy calls and place outbound patient refill calls</li>
<li>✅ Guide patients through the complete medication refill process</li>
<li> Coordinate prescription refills including data entry and pharmacy claim adjudication</li>
<li> Perform prescription status checks and resolve adjudication issues</li>
<li> Serve as a liaison between patients, pharmacists, clinicians, payors, and internal teams</li>
<li> Clarify prescription orders with pharmacists and/or clinicians as needed</li>
<li>❄️ Identify medications requiring special handling (e.g., refrigerated or hazardous)</li>
<li> Accurately manage and update patient and prescription data across systems</li>
<li> Identify trends, resolve recurring issues, and recommend process improvements</li>
<li> Maintain strict confidentiality of sensitive patient and healthcare data</li>
<li> Participate in training, professional development, and quality initiatives</li>
<li><ul><li>Maintain schedule flexibility to meet health system partner needs</li></ul></li>
(8-hour shifts, Monday through Friday between 7am and 7pm EST, weekends as needed)
</ul>
Additional duties may apply as business needs evolve.

<h2 class="jobSectionHeader">What We're Looking For</h2>
<h3 class="jobSectionHeader">Licensure &amp; Certification</h3>
<ul><li><ul><li>National certification (CPhT) required</li></ul></li>
<li>✅ State-registered Pharmacy Technician (obtainable with national certification)</li>
<li>Willingness to obtain additional required licensure within an agreed timeframe 
(continued employment contingent upon licensure compliance)</li>
</ul><h3 class="jobSectionHeader">Experience &amp; Education</h3>
<ul><li> 1&ndash;3 years of pharmacy technician experience preferred
<ul><li>Refill management</li>
<li>Pharmacy claim adjudication</li>
<li>Specialty pharmacy exposure</li>
<li>Clinical care team collaboration</li>
<li>Remote or call-center pharmacy experience (plus)</li>
</ul></li><li> High school diploma or GED required</li>
</ul><h3 class="jobSectionHeader">Key Skills</h3>
<ul><li>Exceptional phone presence and patient communication skills</li>
<li>Comfortable with outbound patient engagement</li>
<li>Strong collaboration skills with clinicians, payors, and pharmacy teams</li>
<li>Proficiency in Microsoft Excel and Word</li>
<li>Ability to quickly learn new systems and workflows</li>
<li>Excellent organization, multitasking, and attention to detail</li>
</ul><h3 class="jobSectionHeader">Attributes for Success</h3>
<ul><li>Empathetic, patient-focused, and service-oriented</li>
<li>Reliable, accountable, and highly dependable</li>
<li>Collaborative team player with a quality mindset</li>
<li>Strong listener and clear communicator</li>
<li>Consistently punctual with minimal unscheduled time off</li>
</ul><h2 class="jobSectionHeader">Remote Work Requirements</h2>

To ensure optimal patient care and team collaboration, remote team members must have:
<ul><li>️ A dedicated desk setup with two company-provided monitors</li>
<li> High-speed, stable, and reliable internet connection</li>
<li> A quiet, distraction-free workspace</li>
<li><ul><li>️ Willingness to work overtime as patient care volumes fluctuate</li></ul></li>
<li> Ability to keep camera on for most meetings with leaders and teammates</li>
</ul><h2 class="jobSectionHeader">Why This Role Matters</h2>

You'll play a vital role in improving medication access, adherence, and patient experience&mdash;while enjoying the flexibility of a remote pharmacy position. Your work directly supports patients, providers, and health system partners every day.
</div><div>
California residents employed by or applying for work at Shields have certain privacy rights. Please review our: California Workforce Privacy Notice and Privacy Policy.
By providing your mobile number, you agree to receive text messages from Shields Health Solutions related to job opportunities, interview scheduling, and recruiting updates. Message and data rates may apply. You may opt out at any time by replying 'STOP.' Consent is not a condition of employment.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.</div></div>

Certified Pharmacy Technician - Refill & Medication Adherence

Ventegra Inc. A California Benefit Corporation

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&rsquo;s physical location. Candidates may reside in other time zones but must be available to work one of the following schedules in PST hours:<ul><li>7:30 a.m. &ndash; 4:00 p.m. HST (Monday&ndash;Friday)</li><li>9:00 a.m. &ndash; 5:30 p.m. HST (Monday&ndash;Friday)</li><li>9:30 a.m. &ndash; 6:00 p.m. HST (Monday&ndash;Friday)</li></ul>Candidates must be able to work from 6:00am - 12:00pm HST for the first few weeks of training. Duties:<ul><li>Maintain database of existing coupons and patient assistant programs involved</li><li>Assess and identify appropriate program(s) for members based on needs</li><li>Coordinate programs between pharmacy, members and plans as needed</li><li>Effectively communicate between the Customer Care Department and Prior Authorization personnel for seamless and efficient member service</li><li>Ensure compliance with all applicable laws and regulations</li><li>Continually evaluates processes and training materials for effectiveness and efficiency of the programs</li><li>Perform QA analysis to ensure appropriate monetary values are being applied to both claim and benefit as applicable</li><li>Develop and document policy and procedures</li><li>Implement new plans to the program</li><li>Term plans as they unenroll from the program</li><li>Assist with member communication as needed when changes to plans are made (i.e. biosimilar conversions)</li><li>Maintain and correct member deductible and maximum out of pocket accumulators as relates to coupon programs</li><li>Assist in other projects as assigned by management</li></ul>Skills/Qualifications:<ul><li>Excellent communications skills (oral, written and interpersonal)</li><li>Analytic skills</li><li>Pharmacy Tech certified required</li><li>Demonstrated ability to work well in a team environment</li><li>Demonstrated ability to provide exceptional customer service</li></ul>Education and Experience:<ul><li>High school diploma or equivalent</li><li>2+ years of experience in pharmacy benefit management, healthcare administration, or a related field.</li><li>Knowledge of pharmacy claim adjudication processes and benefit plan design, a plus</li><li>Familiarity with manufacturer copay and patient assistance programs, a plus.</li></ul>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-timePay: From $18.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Professional development assistance</li><li>Retirement plan</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>Are you able to work a schedule of 7:30am-4:00pm, 9:00am-5:30pm, or 9:30am-6:00pm Hawaii Standard Time?</li><li>Are you able to work a training schedule of 6:00am-12:00pm Hawaii Standard Time ?</li></ul>Experience:<ul><li>Pharmacy technician: 1 year (Preferred)</li><li>Pharmacy Benefit: 1 year (Required)</li></ul>License/Certification:<ul><li>Pharmacy Technician Certification (Preferred)</li></ul>Work Location: Remote

Member Benefit Preservation Specialist

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