Intake Specialist

Position Overview

We are seeking an Intake Specialist to support pharmacy benefit operations within a healthcare environment. This role will coordinate pharmacy-related requests, research and resolve escalated issues, and work closely with internal teams and external Pharmacy Benefit Management (PBM) partners.

Key Responsibilities

• Coordinate daily activities related to pharmacy benefit operations.
• Support pharmacy programs, projects, and operational initiatives.
• Research and resolve escalated customer service inquiries and grievances.
• Coordinate pharmacy benefit plan administration and quality assurance with internal teams and PBM partners.
• Assist with pharmacy claim adjustments and other benefit-related issues.
• Coordinate coverage determinations, claim reconsiderations, and appeals with clinical teams and appropriate partners.
• Serve as a resource for pharmacy-related processes, issues, and initiatives.
• Escalate complex clinical, contractual, or operational issues as appropriate.
• Assist with RFPs, government program applications, and related requests.

Qualifications

• High school diploma or GED required.
• 3+ years of related experience.
• Experience in healthcare, health insurance, pharmacy benefits/PBM, claims, or a related field preferred.
• Strong research, problem-solving, organizational, and communication skills.
• Ability to manage multiple priorities and coordinate effectively across teams.