Claims examiner Jobs in Lincoln, NE

Job Description Sr. Specialist, Pharmacy Claims

Includes Hybrid Work Schedule - must work close enough to commute to the Lincoln, NE location 3 days per week.

Join a Mission-Driven Organization

We're seeking a problem-solver who enjoys tackling complex challenges, investigating and resolving pharmacy claim issues, and delivering exceptional service to our members. Join our Medical Claims team in Lincoln, NE, and make a meaningful impact by helping ensure accurate and timely claims resolution

We're proud to be named one of Lincoln's Best Places to Work—and we're looking for people who care deeply about helping others and want to grow with a mission-driven organization.

About NRECA

NRECA is the national trade association representing more than 900 consumer-owned electric cooperatives across the United States. We provide advocacy, financial services, and business solutions that help over 900 consumer-owned electric cooperatives across the country serve their communities and we operate with integrity, transparency, and a spirit of innovation.

The work in the Insurance & Financial Services department (I&FS) is dynamic and intellectually challenging, engaging, and deeply impactful. They work to develop and administer employee benefit plans and services which are diverse and the results help improve the quality of life for hard working Americans across the country. They foster a culture that emphasizes a strong sense of diversity, integrity, and belonging, driven by NRECA's core values like communication, creative problem-solving, collaboration and accountability. If you're motivated by purpose, enjoy variety, and care about people and outcomes, this is the team for you.

Position Summary

As a Sr. Specialist, Pharmacy Claims, you'll resolve pharmacy claim issues, be the go-to expert for pharmacy benefit questions and escalation, and identify opportunities to improve processes, systems, and service delivery.

The work schedule is 8:15 a.m. to 5:00 p.m. and the position is eligible for NRECA's hybrid schedule which allows flexibility to work from home up to 2 days per/week.

Key Responsibilities

• Troubleshoot pharmacy claim issues
• Answer questions from members and providers.
• Work with internal and external partners to resolve complex benefit concerns.
• Balance investigative work with customer service while also looking for opportunities to improve processes and prevent future issues.

Qualifications Education, Experience, and Certifications (required and preferred)

Required Education and Certifications:

• Associate's degree in a related field (health administration, pharmacy technician, desired), or combination of education and experience;

• Certification in a medical terminology course or coursework in medical anatomy.

Preferred Education:

• Insurance coursework such as LOMA, AHIP, ICA or CEBS, desired.

Required Experience:

• 7 or more years of experience with prescription claims processing for commercial insurance carriers.

• 5 years of experience working in a pharmacy; or 5 years' experience with a PBM in a group insurance setting.

Knowledge, Skills and Abilities (required or preferred and as demonstrated by prior work experience.)

• Knowledge of pharmacy benefit management (PBM), including benefit design, coverage limitations, and formulary processes.

• Understanding of applicable regulations, including HIPAA, ACA, Medicare Part D, and other federal mandates.

• Knowledge of pharmacy and health claims operations, compliance requirements, and contractual plan language, with the ability to interpret and apply medical, technical, and contractual information to claims.

• Strong analytical and critical thinking skills, with the ability to identify issues, evaluate information, and draw sound conclusions.

• Excellent interpersonal and customer service skills.

• Effective verbal and written communication skills, with the ability to interact professionally with members, employees, and vendors.

• Ability to exercise sound judgment, discretion, and decision-making in a fast-paced environment.

• Proficiency with Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.

• Ability to develop and deliver presentations, training, and educational sessions.

• Ability to report to the office as required

Essential Physical Requirements

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

• Primarily sedentary work with extended periods of sitting.

• Visual acuity is sufficient for computer work and data analysis.

• Manual dexterity for frequent keyboard use.

• Occasional light lifting (up to 10 lbs).

• Effective communication in person, by phone, and via email.

Salary Range: $68,000 - $80,000

Final Compensation determined by individual qualifications, experience, and internal equity.

Disclaimer Statement: The preceding job description has been written to reflect management's assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned.

Additional Requirement:

The preceding job description has been written to reflect management's assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

NRECA is committed to working with and providing reasonable accommodation to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail humanresources@nreca.coop or call: 703-907-5992 - NRECA Arlington Human Resources. Please call 402-483-9275 - NRECA Lincoln Human Resources, for Lincoln, NE employment opportunities. We will make a determination on your request for reasonable accommodation on a case-by-case basis.

The U.S. Equal Employment Opportunity Commission (EEOC) recently released the 'Know Your Rights' poster, which updates and replaces the previous "EEO is the Law" poster and "EEO Is the Law Poster Supplement".

Pay Transparency Non-Discrimination. NRECA will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. Please see the Pay Transparency Nondiscrimination Provision for more information.

E-Verify. As a Federal Contractor, NRECA is required to participate in the E-Verify Program to confirm eligibility to work in the United States. For information please click on the following link: E-Verify.

For more information about life at NRECA please visit www.Electric.coop.