Helping make health care for Californians easy, accessible and reasonably priced
is a great calling. Knowing that your company has channeled over $100 million
back into California communities and will continue to do so is flat out
uplifting. Join the hardest working, not-for-profit health plan in California
and be part of the solution.


Under supervision of the Claims Operations Supervisor
• Responsible for working in coordination with the claims processing vendor to
implement electronic drug utilization edits
• Identify root cause and resolve claims processing issues for both Commercial
and Medicare lines of business.
• Provides support for the compilation and testing of claims data required for
pharmacy claims audits
• Proactively identifies provider or employer group concerns, related to claims
adjudication issues, and works to identify root cause and resolution.
• Act as liaison between Rx services and high profile employer groups to provide
personalized service when directed.
• Provide subject matter expertise to the Pharmacy Communications Team to assist
in developing communications materials related to pharmacy claims issues for
internal & external constituents.
• Assist...

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