Pharmacy Operations Specialist II (FWA)

Pharmacy Operations Specialist II (FWA)

Position Purpose: This role will focus on ensuring that the administration of the pharmacy program is accurate and compliant by supporting various operational tasks. This role will serve as the subject matter expert supporting various pharmacy operations tasks including but not limited to claims, formulary, benefit, and networks.

Key Details: This is a remote, day-shift position working Monday through Friday with a start time between 8:00 AM and 9:00 AM Eastern or Central Time. In this role, you will be responsible for supporting PBM oversight and internal activities related to pharmacy fraud, waste, and abuse (FWA), as well as pharmacy audit functions. Some key recurring tasks include joining PBM operational calls to support the follow-up and resolution of open items related to the department and implementing and maintaining accurate and compliant member and provider communication processes for Pharmacy FWA-related communications through the PBM and/or internal processes. You will partner with internal teams, health plans, and PBM partners to support member and provider communications, regulatory reporting, operational metrics, and pharmacy network activities. This role is responsible for ensuring accurate, timely, and compliant processes while supporting issue resolution, documentation updates, and ongoing process improvement initiatives. The ideal candidate brings managed care experience working with pharmacy claims or PBM data, strong attention to detail, excellent organizational and communication skills, and the ability to manage multiple priorities independently. Advanced Excel skills, experience with tools such as Power BI and/or Power Automate, and strong data analysis skills would be beneficial in this role and are used to support reporting and analytics.

• Ability to conduct data analysis to support operations and exercise independent judgement

• Provides support for escalated issues and special projects as assigned

• Conduct UAT to ensure that systems reflect accurate information

• Serve as the subject matter expert supporting various pharmacy operations tasks including but not limited to claims, formulary, benefit, and networks

• Serve as the subject matter expert related to specific pharmacy documents to ensure they are accurate and compliant

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Highschool Diploma or GED, Bachelor’s degree preferred, 4+ years of pharmacy experience, including 1+ year of managed care experience. Government sponsored program (Medicare and/or Medicaid) experience preferred.

License/Certification: Current state’s Pharmacy Technician license preferred

Please attach an up-to-date resume that meets Education / Experience requirements to your application.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act