Support pharmacy benefit operations by coordinating clinical and administrative workflows.
Review documentation and communicate with members, providers, and internal stakeholders.
Ensure accurate and compliant processing of pharmacy benefit requests.
We are an innovative company striving to reduce the cost of healthcare. We have a tight-knit culture based on an outward mindset and are growing quickly.
Respond to member and provider inquiries about Medicare benefits, claims, and enrollment via phone and email.
Analyze issues, document outcomes, and maintain accurate records in internal systems.
Collaborate across departments to resolve service issues and support contact center documentation.
Curana Health provides value-based primary care services for the senior living industry, including skilled nursing facilities and assisted living communities. With over 1,000 clinicians serving more than 1,500 communities across 34 states, the company has experienced rapid growth since 2021 and participates in innovative CMS programs.
Assist patients with enrolling in our Prescription Payment Plan and verifying eligibility.
Coordinate with pharmacies to apply benefits and reduce out-of-pocket costs.
Guide patients through renewals and updates to ensure continued access.
We are a team dedicated to improving access to affordable prescription medications for patients. We partner with insurance companies, healthcare providers, and pharmacies to reduce the financial burden of medications, ensuring patients can access treatments without excessive costs.
Provide empathetic, high-touch support to patients, answering non-clinical questions and navigating their care.
Support providers with administrative tasks in the EMR, triaging messages and resolving issues.
Coordinate with clinical, pharmacy, and insurance teams to resolve complex patient needs.
Ro is a direct-to-patient healthcare company offering telehealth, labs, and pharmacy services nationwide. With over 1,200 employees, Ro is recognized as a top workplace, fostering a culture of innovation and diversity.
Make outbound calls to eligible patients to enroll them in the Shields Partner Pharmacy program and explain the benefits of the service.
Access patient EMR and review chart notes to ensure familiarity with their condition before each call.
Identify medications requiring special handling and necessary supplies such as sharps containers or needles.
Shields Health Solutions is a specialty pharmacy services company that partners with health systems to provide comprehensive pharmacy care. They offer a supportive culture with benefits starting day one and opportunities for professional development.
Handle inbound and outbound calls to resolve patient issues, process reorders, and ensure accurate billing.
Obtain and process authorizations while maintaining patient confidentiality and documentation.
Maximize patient retention through cross-selling and provide cross-functional support across business units.
CCS is a healthcare company specializing in chronic care management through its LivingConnected® platform, using data-driven insights to improve patient outcomes. It supports over 200,000 people annually and is recognized as a Great Place to Work®, fostering a patient-centric culture.
Oversee a team of Patient Outreach Coordinators and Onboarding Specialists to ensure compliant and effective patient communications.
Coach team members on calling best practices and conversational techniques to address patient concerns.
Manage workflows, audits, and collaboration with hospital sites to optimize outreach operations.
Shields Health Solutions partners with hospitals to enhance their pharmacy services by connecting patients with hospital-based pharmacies. The company is dedicated to improving patient care and operates with a focus on teamwork and growth.
Provide high-touch operational support and specialized coordination across customer workflows.
Manage complaint and escalations investigations and resolution end to end.
Collaborate cross functionally with internal teams to resolve issues and advocate for clients.
Lyra Health provides evidence-based mental health care, serving over 20 million people globally. The company has published more than 35 peer-reviewed studies and delivered unmatched outcomes.
Provide efficient, courteous service to members, providers, and other customers via phone, email, and more.
Resolve routine and moderately complex inquiries about enrollment, billing, benefits, claims, and other topics.
Research inquiries, interpret policies, and ensure accurate, timely responses to meet customer satisfaction.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association providing health insurance and related services. They value a flexible, supportive work culture and prioritize employee growth, consistently being voted one of the “Best Places to Work in PA.”
Provide support to participants and clients regarding eligibility, benefits, claims, and general plan inquiries via phone and email.
Document all customer interactions accurately in the call tracking system and navigate multiple systems to assist customers.
Maintain confidentiality in accordance with HIPAA standards and contribute to a positive, team-oriented environment.
Point C is a National third-party administrator that delivers customized self-funded benefit programs. They are a mission-driven company focused on innovative cost containment strategies.
Review, process, and troubleshoot incoming Prior Authorization requests for various medications.
Accurately process requests according to regulatory and client-specific guidelines while meeting departmental performance metrics.
Work with clinical teams and handle requests via phone, fax, and web submission.
Navitus is a pharmacy benefit manager (PBM) alternative focused on reducing drug costs to make medications more affordable. The company offers a diverse and creative work environment with numerous employee benefits and growth opportunities.
Manage end-to-end patient access case activities including benefit verification, prior authorization, appeals, and pharmacy coordination.
Apply pharmacy technician knowledge to review prescriptions, identify barriers, and coordinate with providers, payors, and pharmacies.
Maintain accurate case documentation and communicate effectively with patients, healthcare professionals, and internal teams.
PRO-spectus is a patient services company that strategically navigates the patient access process from prescription intake through treatment initiation. The company fosters a supportive, teamwork-driven culture with a focus on improving patient lives, though its exact size is not specified.
Answer inbound calls from Medicare Advantage members and providers with empathy and professionalism.
Handle inquiries regarding benefit eligibility, enrollment, and claims status while conducting thorough research.
Navigate multiple systems to resolve issues and advocate for members, ensuring first-call resolution.
Johns Hopkins Health Plan provides health insurance services to members. It is part of the Johns Hopkins Health System, a large organization with a diverse team of healthcare professionals.
Manage multiple channel interactions professionally and efficiently.
Address provider inquiries with accuracy and focus on first call resolution.
Maintain positive relationships and exceed quality and productivity goals.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association focused on improving the health and well-being of its members and communities. It has been consistently voted one of the Best Places to Work in PA and fosters a flexible, supportive culture with emphasis on professional growth and community involvement.
Manage post-sale success and retention of assigned clients as a trusted advisor to operational leadership.
Build client success plans, coordinate cross-functional teams, and drive resolution of escalated issues.
Identify product gaps and attrition risks, complete reporting, and support data activities for client goals.
SmithRx is a venture-backed health-tech company disrupting pharmacy benefit management with a modern drug acquisition platform. Since 2016, it has onboarded hundreds of thousands of members and fosters a mission-driven, collaborative culture.
Serve as first point of contact for members and providers via phone and email, resolving health insurance inquiries.
Use active listening and empathy to understand issues, explain benefits, claims, and coverage, and document interactions.
Maintain a structured schedule, with availability during peak season, and uphold the Gravie CARE service model and core values.
Gravie creates innovative health benefits for small and midsize businesses, focusing on solutions that genuinely benefit employees. The company is well-funded, non-hierarchical, and merit-driven, with a culture that values authenticity, curiosity, and creativity.
Conduct educational telephone calls to advise members of benefits, complete health needs assessments, and refer to population health management programs.
Reach out to members with gaps in care, encourage compliance, and assist with locating providers and scheduling appointments.
Manage system work queues, screen members for eligibility and history, and assign to clinical teams for intervention.
BlueCross BlueShield of Tennessee is the state's largest health benefit plan company, helping Tennesseans find paths to good health since 1945. They are a remote-first organization with many employees working from home, fostering a culture of innovation and collaboration.
Educate healthcare providers about BlinkRx benefits to improve patient medication adherence.
Conduct proactive outbound calls to provider offices to expand usage and build relationships.
Act as the first point of contact for provider inquiries, creating custom profiles for preferences.
Blink Health is a healthcare technology company that builds products to make prescriptions accessible and affordable, with a focus on BlinkRx and Quick Save. They are a highly collaborative team of builders and operators working to innovate in the healthcare industry.
Triage clinical program calls, schedule consultations, and conduct outreach to members, prescribers, and pharmacies.
Monitor outreach queues, document case activities, and escalate issues to ensure timely completion of clinical programs.
Maintain compliance with HIPAA and internal SOPs while providing compassionate, professional support to members and providers.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. They consolidate pharmacy and medical benefits on a unified platform, leveraging AI-powered care delivery to enhance efficiency and service. The company is a growing startup focused on transforming healthcare infrastructure.