customer benefit plan manager

Community Health Choice

<p><b>Job Overview</b><br/>Under the direction of the Manager, Managed Care Pharmacy Operation, the Pharmacy Program Specialist II supports the operational needs of the pharmacy team by managing prior authorization processes, coordinating communication between members and providers, and addressing issues with the Pharmacy Benefit Manager (PBM). The role requires a strong understanding of medical benefit drug coverage and adherence to regulatory timelines. The specialist also contributes to reporting, monitoring delegated PBM functions, and promoting member adherence, while delivering a high level of customer service.</p><p>QUALIFICATIONS:</p><p>Required Preferred Education/Specialized Training/Licensure: Bachelor&rsquo;s degree in healthcare field, or in business administration Actively registered with the Texas State Board of Pharmacy as a certified pharmacy technician</p><p>Work Experience (Years and Area): Minimum Three (3) years&rsquo; experience with a Health Plan or PBM in related functions Strong experience with prior drug authorization process in a Health Plan or PBM</p><p>Pay: $23.46 - $29.32 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: Hybrid remote in Houston, TX 77081</p>

Pharmacy Program Specialist II

EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Support eligibility and benefits configuration and deployment, including collaboration with pharmacy benefits manager (PBM) and Cognizant, formulary teams, for configuration. Responsible for Quality Assurance and Testing for operations and implementations. Coordinate and manage the pharmacy plan/ benefit design implementation process in partnership with PBM to ensure the accuracy and timeliness of members&rsquo; pharmacy benefit administration for superior member experience.</div><div>
Responsibilities</div><ul><li>
Maintain in-depth understanding of and ability to create and maintain plan/benefit design rules and limitations to include: Adjudication rules, Clinical rules, Payment rules, and Plan/group management.<br>
</li><li>
Partner with Sales and Product teams, assist in developing pharmacy benefit plan designs, meeting client requests, Health Plan strategic/ business parameters and all regulatory and other oversight agencies&rsquo; requirements.<br>
</li><li>
Responsible for creating and maintaining plan/benefit design documentation to support internal and external requirements<br>
</li><li>
Lead communication and coordination between Health Plan and PBM for receipt of required information for claims adjudication system set up, reporting and claim adjudication process.<br>
</li><li>
Assess all requests for new/ changes to plan benefit information to ensure compatibility with PBM claim adjudication logic.<br>
</li><li>
Submit accurate and complete requests to the PBM for new and changing benefit plan designs.<br>
</li><li>
Test pharmacy benefit plan designs for accuracy and alignment with business requirements.<br>
</li><li>
Serve as liaison to PBM to troubleshoot and resolve benefit-related questions/ issues, researching plan/benefit design options and requirements.<br>
</li><li>
Participate in PBM implementation meetings as required.<br>
</li><li>
Review and approve PBM benefit set up requirements.<br>
</li><li>
Perform claim testing to ensure accurate claim adjudication.<br>
</li><li>
Work with the pharmacy clinical team to implement formulary updates in the claim adjudication system.<br>
</li><li>
Participate in the research and resolution of claims adjudication-related discrepancies, errors, and problems.<br>
</li><li>
Acts as a resource to operational areas in support of the pharmacy claims adjudication process and responding to issues related to plan/ benefit design.<br>
</li><li>
Conduct quarterly audits of pharmacy benefit configurations to ensure alignment with plan design, regulatory requirements, and accurate claim adjudication across all lines of business.<br>
</li><li>
Recommend streamlined work processes and systems that impact plan/ benefit design to create efficiency and quality outcomes.<br>
</li><li>
Maintain acceptable and appropriate quality levels and production SLA response time.<br>
</li><li>
Perform other projects and duties as assigned</li></ul>
<div><div>Qualifications</div><ul><li>
Bachelor&rsquo;s degree.<br>
</li><li>
Pharmacy Technician Certification (Required)<br>
</li><li>
Additional years of related experience may be considered in lieu of degree (Required)<br>
</li><li>
Ability to perform in office environment with extended periods of sitting, using telephone, and viewing computer screens (Required)<br>
</li><li>
Ability to prioritize tasks daily and trouble shoot urgent customer issues to successful completion (Required)<br>
</li><li>
Advanced knowledge of MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)<br>
</li><li>
Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues within Operations (Required)<br>
</li><li>
Professionally skilled in verbal and written communication (Required)<br>
</li><li>
Meticulous organization skills, with the ability to multi-task, and ability to make sound decisions in a timely and independent manner (Required)</li></ul>
</div><div><p>Additional Information
</p><ul><li>Requisition ID: 1000003022</li>
<li>Hiring Range: $56,160-$99,360</li></ul></div></div>

Pharmacy Benefits Operations Specialist - Remote

Cope Plastics Inc

<div><p>Perfect fit for a passionate individual with a detailed approach to sales and customer service. Our goal is to provide excellent customer service to our customers, providing quality products and long-term solutions along the way.
</p><p>In addition to a comprehensive compensation plan that includes <b>base salary and commissions</b>, the Account Manager will enjoy the following benefits as a Cope Plastics Inc. employee:</p><ul><li>
Competitive benefit package (Group Health &amp; Dental and Vision Insurance)</li><li>
401(k) Plan with Company Match</li><li>
Short-term Disability Insurance</li><li>
Life Insurance</li><li>
Substantial paid holiday schedule</li><li>
Immediate time-off earnings</li></ul><p>
</p><p><b>Essential Functions:</b></p><ul><li>
Prospects new business opportunities and identifies revenue opportunities.</li><li>
Provides material and application assistance, determines customer needs and recommends products and/or fabrication services.</li><li>
Calculates pricing for quotes, material yields and labor to optimize profit margin.</li><li>
Confers and shares information about customers and order status with sales team.</li><li>
Manages the order entry and flow process to ensure customer satisfaction.</li><li>
Works with Branch Manager, Outside Sales and Market Managers on competitive, strategic pricing situations and market conditions, key and target account projects and new products.</li><li>
Travels as required to customer sites, trade shows, sales training, company-wide sales meetings.</li></ul><p><b>
Position Qualifications and Requirements:</b></p><ul><li>
Requires a HS diploma or GED, plus a minimum of two years college education OR equivalent capabilities.</li><li>
A minimum of three years industrial sales and/or customer service experience preferred.</li><li>
Excellent customer interaction and communication is an absolute must. Industrial sales experience is a plus.</li></ul></div>

Account Manager (Inside Sales)

Keefe Group

<div>Wage Rate: $21-24.00/Hour Overview:
<div>TKC Holdings, Inc.&mdash;comprised of Trinity Services Group, Keefe Group, and Courtesy Products - is a mid market respected leader in the corrections and hospitality industries for more than 40 years. With thousands of team members across the country, we continue a tradition of innovation, integrity, and success. TKC is committed to delivering excellent products and services, exceeding customer expectations, and empowering the career development of every team member.</div><div></div><div><br>
We are proud to be a military and veteran-friendly employer.</div>
About This Position:
<div><b>Schedule:</b></div><div><b>
Monday - Friday</b></div><div><b>
8am - 5pm</b></div><div>
</div><div>
To provide a central resource for customers, sales and regional KCN staff members in account and item set up, maintenance and general support.</div><div></div><div><div><br>
Essential Functions, Duties, and Responsibilities</div><ul><li>
Answer phones and log calls</li><li>
KCN Customer master file maintenance in Oracle</li><li>
Research/reconcile customer billing inquiries</li><li>
Assist in the review and collection of KCN receivables</li><li>
Process payables for payment of KCN vendor invoices</li><li>
Process vendor invoices for approval and payment</li><li>
Release, review accuracy, and mail invoices to all KCN customers</li><li>
Filing of customer invoices and credits in a timely manner</li><li>
Assist in preparation of spreadsheets for KCN monthly reports</li><li>
Regular activity reporting to manager</li><li>
Monitor inventory of equipment at customer locations and not yet placed</li><li>
Book travel arrangements for staff</li><li>
Assist in documenting procedures for regional KCN staff and distribution centers</li><li>
Maintain office supply inventory</li><li>
Back up Secretary-Receptionist/General Office Staff as needed</li><li>
Complete miscellaneous duties and assignments as assigned by Manager</li></ul></div>
What You'll Need:
<ul><li>High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.</li><li>
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence.</li><li>
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.</li><li>
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.</li><li>
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.</li><li>
Valid Photo ID</li><li>
Must be a self-starter who can work well with people at all levels both in and out of KCN Organization and correctional facilities in a professional manner.</li><li>
Ability to prioritize projects from several sources and departments.</li><li>
Ability to work well with ever changing priorities and or situations.</li><li>
Strong organizational skills.</li><li>
Ability to work independently or within a team.</li><li>
Customer service oriented.</li><li>
Excellent telephone and communication skills.</li><li>
10-key calculator experience.</li><li>
General office machine experience.</li><li>
PC experience required &ndash; word processing and spreadsheet generation (including Microsoft Office programs).</li><li>
Familiarity with computers (including Microsoft Office programs) preferred</li></ul>
Benefits:
<p>
TKC Holdings, Inc. offers comprehensive benefits to all regular-full time employees:</p><ul><li>
Medical w/prescription coverage</li><li><ul><li>
Benefit Credit received when enrolled in a TKC medical plan, to help offset your benefit costs. Benefit Credit of $750 annually, will be divided evenly among your paychecks throughout the Plan Year.</li></ul></li><li>
Dental</li><li>
Vision</li><li>
Basic Life and Basic Accidental Death and Dismemberment Insurance</li><li>
Voluntary benefits (i.e. short term, long term disability and many more) options may be selected to create the right package for you</li></ul><p>
TKC also understands the importance of work life balance and planning for the future. To help with both of these, employees are eligible for paid time off and a Company Match for the 401(k) Retirement Savings Plan. We now also offer DailyPay providing you immediate access to earned wages.</p>
EEO Statement:
<div>
Equal Employment Employer as to all protected groups, including protected veterans and individuals with disabilities.</div><div>
We maintain a drug-free workplace.</div><div></div><div><br>
A copy of our Privacy Policy and CA Employee Privacy Notice can be found here: <i>https://tkcholdings.com/privacy-policy-108</i></div></div>

Administrative Assistant

Reimagined Parking

<div>
 <strong>
  Address: 1 Terminal Dr, Middletown, PA 17057
  <br/>
  <br/>
  Job Title: Ambassador
  <br/>
  <br/>
  Pay: $15/hr.
  <br/>
  <br/>
  Shift: Overnight
  <br/>
  <br/>
 </strong>
 The Garage Ambassador greets and creates a welcoming atmosphere for our customers and clients. They perform a variety of tasks to ensure a smooth operation of the parking facility, while delivering service that exceeds our customer/client's expectations. Depending on the needs of the location the Garage Ambassador provides customer service, including helping customers with entry/exit transactions, maintaining parking equipment in operating condition with receipt paper and free of jams, and troubleshoot and parking equipment that is malfunctioning. The Garage Ambassador works closely with fellow team members, Operations Manager, and/or Shift Supervisor to ensure that cleanliness as well as safety standards are met at all times.
 <br/>
 <br/>
 Key Responsibilities
 <br/>
 <br/>
 <ul>
  <li>
   Must be flexible to work nights Monday-Sunday, Holidays and special events.
  </li>
  <li>
   Greet arriving and departing guests in a friendly and courteous manner.
  </li>
  <li>
   Act as traffic controller to direct incoming guests to available parking spaces.
  </li>
  <li>
   Perform vehicle counts on location throughout shift to ensure garage does not over fill available spaces.
  </li>
  <li>
   Perform daily patrols and issue violation warnings to tenants and visitors that violate garage policies.
  </li>
  <li>
   Control traffic at entrances and exits as needed; provide assistance to guests who have forgotten where they parked.
  </li>
  <li>
   Assist in the maintenance and repair of parking equipment and any general maintenance tasks as directed by the Garage Manager or Operations.
  </li>
  <li>
   Use respectful communication to assist guests with their questions, problems, and concerns, relay information to Operations Manager
  </li>
  <li>
   Immediately report any accidents, incidents or safety concerns to Operations Manager or Shift Lead.
  </li>
  <li>
   Always communicate professionally with guests, client, and teammates.
  </li>
  <li>
   Employee must be able to perform essential functions of the position with or without reasonable accommodations.
  </li>
  <li>
   Basic knowledge of the parking system to add, cancel or reset key cards.
  </li>
  <li>
   Oversee upkeep of the garage &ndash; look for large debris, lights out or anything that can be a hazard. Please report immediately to superiors to inform client.
   <br/>
   <br/>
  </li>
 </ul>
 Skills, Knowledge and Expertise
 <br/>
 <br/>
 <ul>
  <li>
   At least 18 years of age
  </li>
  <li>
   Excellent customer service and communication skills
  </li>
  <li>
   Ability to verbally communicate with guests
  </li>
  <li>
   Previous customer service experience, preferred
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Benefits
  <br/>
  <br/>
 </strong>
 Join our team and enjoy an outstanding benefits package, including:
 <br/>
 <br/>
 <strong>
  (Full Time Only)
  <br/>
  <br/>
 </strong>
 <strong>
  Generous Paid Time Off
 </strong>
 : Enjoy 10 days of paid time off, plus 8 paid holidays, so you can rest and recharge.
 <br/>
 <br/>
 <strong>
  Comprehensive Health Plans
 </strong>
 : Access top-notch Medical, Dental, and Vision coverage for you and your family.
 <br/>
 <br/>
 <strong>
  Life and Disability Insurance
 </strong>
 : Company paid basic life and Short-Term Disability to secure your future with essential protection for you and additional options for your loved ones.
 <br/>
 <br/>
 <strong>
  401(k) Plan
 </strong>
 : Benefit from a generous employer match with immediate vesting to help you save for retirement.
 <br/>
 <br/>
 <strong>
  Employee Assistance Program:
 </strong>
 Access behavioral Health Care to assist with personal needs for you and your family members.
 <br/>
 <br/>
 <strong>
  Parental and Caregiver Leave
 </strong>
 : Enjoy time off to support your growing family or care for loved ones.
 <br/>
 <br/>
 <strong>
  (Part Time)
  <br/>
  <br/>
 </strong>
 <strong>
  401(k) Plan
 </strong>
 : Benefit from a generous employer match with immediate vesting to help you save for retirement.
 <br/>
 <br/>
 <strong>
  Sick Time Off
 </strong>
 : Prioritize your health and well-being with paid sick leave based on state laws and regulations.
 <br/>
 <br/>
 <strong>
  Employee Assistance Program:
 </strong>
 Access behavioral Health Care to assist with personal needs for you and your family members.
</div>


Overnight Ambassador Harrisburg Airport

Joyner Homes

<div>
 <strong>
  Joyner Homes
  <br/>
  <br/>
 </strong>
 <strong>
  Residential Construction Project Manager
  <br/>
  <br/>
 </strong>
 <strong>
  Location:
 </strong>
 Greenfield, IN (On-site; field-based across Central Indiana job sites)
 <br/>
 <br/>
 <strong>
  Lead Homes from Plan to Finish with Integrity
  <br/>
  <br/>
 </strong>
 <strong>
  Joyner Homes
 </strong>
 builds distinctive custom homes with a focus on craftsmanship, livability, and smart design. Based in Greenfield and building across Central Indiana, the company combines small-town values with high standards, giving team members the chance to take ownership, build strong customer relationships, and contribute to homes that truly stand out.
 <br/>
 <br/>
 <strong>
  Joyner Homes
 </strong>
 is looking for a
 <strong>
  Construction Project Manager
 </strong>
 to oversee the coordination, scheduling, and supervision of new home construction. This role is ideal for someone with residential construction experience who enjoys managing multiple projects, communicating with subcontractors and homeowners, and keeping jobs moving with quality, accuracy, and professionalism. The
 <strong>
  Project Manager
 </strong>
 serves as a key point of contact throughout the build and helps ensure each home is delivered to
 <strong>
  Joyner Homes'
 </strong>
 standards.
 <br/>
 <br/>
 <strong>
  Key Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage the construction timeline and schedule for 10-15 homes at a time
  </li>
  <li>
   Review plans and specifications to ensure construction is completed correctly
  </li>
  <li>
   Coordinate subcontractors and vendors for timely project completion
  </li>
  <li>
   Communicate with homeowners as the main point of contact during construction
  </li>
  <li>
   Conduct punch-outs at various construction stages to identify errors and issues
  </li>
  <li>
   Identify plan or field issues and communicate solutions to management, customers, and trade partners
  </li>
  <li>
   Process and communicate change orders
  </li>
  <li>
   Review invoices and identify items that should be back-charged
  </li>
  <li>
   Facilitate customer meetings such as home visits and walkthroughs
  </li>
  <li>
   Maintain site cleanliness, organization, and professionalism
  </li>
  <li>
   Update schedules and construction software regularly
  </li>
  <li>
   Support additional project coordination tasks as needed
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High school diploma required; bachelor's degree in a related field preferred
  </li>
  <li>
   2 to 5 years of residential construction, project supervision, or related experience
  </li>
  <li>
   Valid driver's license required
  </li>
  <li>
   Construction knowledge and scheduling experience
  </li>
  <li>
   Strong written and verbal communication skills
  </li>
  <li>
   Strong customer service and relationship management skills
  </li>
  <li>
   Organized, detail-oriented, and self-motivated
  </li>
  <li>
   Able to manage multiple homes and priorities at once
  </li>
  <li>
   Functional computer skills in Word, Excel, Outlook, and construction scheduling software
  </li>
  <li>
   Positive attitude, initiative, and team-player mindset
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Pay And Benefits
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Full-time, W-2 employment
  </li>
  <li>
   Pay: $75,000 to $85,000 per year, based on experience
  </li>
  <li>
   Per-home bonus potential (details discussed during hiring process)
  </li>
  <li>
   Tenure-based December bonus
  </li>
  <li>
   15 days PTO
  </li>
  <li>
   8 paid holidays
  </li>
  <li>
   ICHRA Health Insurance Benefit
  </li>
  <li>
   Simple IRA Retirement Benefit
  </li>
  <li>
   Company vehicle provided for job site visits
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Why Joyner Homes
  <br/>
  <br/>
 </strong>
 At
 <strong>
  Joyner Homes
 </strong>
 ,
 <strong>
  Project Managers
 </strong>
 are trusted to lead, communicate, and solve problems in a company that values both performance and work-life balance. You'll join a builder that expects initiative and accountability, but also believes in supporting its people, honoring its commitments, and building homes and relationships the right way.
 <br/>
 <br/>
 <em>
  Joyner Homes is an equal opportunity employer committed to diversity and inclusion. We do not discriminate based on any protected characteristic under federal, state, or local law.
 </em>
</div>


Residential Construction Project Manager

Ventegra Inc. A California Benefit Corporation

<p>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.</p><p><b>Schedule: </b>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:</p><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><p><b>Candidates must be able to work from 6:00am - 12:00pm HST for the first few weeks of training. </b></p><p>Duties:</p><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><p>Skills/Qualifications:</p><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><p>Education and Experience:</p><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><p><b>About Ventegra: </b>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.</p><p>Job Type: Full-time</p><p>Pay: From $18.00 per hour</p><p>Benefits:</p><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><p>Application Question(s):</p><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><p>Experience:</p><ul><li>Pharmacy technician: 1 year (Preferred)</li><li>Pharmacy Benefit: 1 year (Required)</li></ul><p>License/Certification:</p><ul><li>Pharmacy Technician Certification (Preferred)</li></ul><p>Work Location: Remote</p>

Member Benefit Preservation Specialist

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