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Pharmacy Operations Representative at Health Care Service Corporation

Pharmacy Operations Representative

Health Care Service Corporation Richardson, TX (On Site) Full-Time
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

As a valued member of our Pharmacy Operations team, you would be responsible for providing assistance to the customer service team, pharmacy coordinators, pharmacists and members in resolution of various pharmacy claims, pricing, coding issues. Working with internal departments and external vendors to evaluate and resolve pharmacy related issues.



*Licensed/Certified Pharmacy Technician.

*Bachelor's degree in Business or a related health care field OR four years work experience in a health care/managed care/insurance industry.
*Verbal and written communication skills.
*Managed care customer service experience.
*Demonstrated proficiency of word processing spreadsheets and database software (excel).
*Drug information skills.
*Handle multiple tasks and strong organizational skills.

*Computer skills to include Excel and PowerPoint experience.

* Retail or Specialty Pharmacy experience.
*Communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits.
*Maintain process for clinical overrides and QVT, Step Therapy and prior-authorization efforts in the PBM claims systems for UM and Clinical Services. Ensure the timely and accurate processing of overrides.
*Communicate with pharmacy personnel, PBM, etc. to resolve claims and coverage issues and explain proper claims submission procedures.

*Coordinate the effective resolution of Pharmacy Benefits administration problems with the appropriate Sales or Marketing Representatives, FSU, Legal, etc. as needed.

We offer a flexible work arrangement of 3 days in office and 2 days working from home from any of the following offices - > Chicago, IL - Quincy, IL - Richardson, TX, Tulsa, OK - Albuquerque, NM.

Relocation is not available at this time.
Sponsorship is not provided.


We encourage people of all backgrounds and experiences to apply. Even if you don't think you are a perfect fit, apply anyway - you might have qualifications we haven't even thought of yet.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Recommended Skills

  • Claim Processing
  • Clinical Works
  • Coordinating
  • Customer Service
  • Databases
  • Managed Care
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