Operations Support Specialist
About this role
Overview
Who We Are
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.
Learn even more about the work that drives us at personifyhealth.com.
Responsibilities
Ready To Keep Pharmacy Funding Accurate and Moving Across a High-Volume TPA Operation?
Why This Role Matters
Pharmacy benefit transactions move real money, fast — wire transfers, netting arrangements, rebate credits. When the reconciliation is off, funding gets delayed and trust accounting gets messy. This role exists to keep PBM invoices, claims data, and funding records in sync, catching discrepancies before they become bigger problems.
What You'll Actually Do
Process PBM invoices and Rx billing: Review incoming invoices and billing statements, monitoring email and system inboxes for pharmacy-related transactions, funding requests, and vendor communications.
Reconcile invoices against claims data: Compare billed amounts, adjudicated claims, and remittance information to identify discrepancies, and escalate them when they don't add up.
Support PBM funding workflows: Track wire transfers, netting arrangements, and rebate credits, coordinating with Trust Accounting to ensure payments post accurately and on time.
Provide operational backup: Pull documentation, support audits, and assist Claims Operations with additional tasks as assigned.
Qualifications
What You Bring to Our Team
Education & Experience
- High school diploma or GED
- Knowledge of medical terminology and ICD-10, CPT, and HCPCS coding
- Experience working in medical insurance companies
- Experience with QicLink and/or Eldorado claims systems is a plus
Technical Skills
- Proficiency in Word, Excel, and Outlook
- Working understanding of medical claims processing
Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.
Company at a glance
We are the first and only personalized health platform to provide health plan administration, holistic wellbeing solutions, and comprehensive health navigation – all in one place. Personalized, human-centric, and powerfully simple, Personify Health helps businesses optimize investments in their members while empowering people to engage more deeply with their health.
Personify Health aims to address the issues of increasing healthcare costs and complexity by breaking down traditional silos found in healthcare and rejecting a one-size-fits-all mentality. Backed by decades of experience and global operations, the company brings together industry-leading health, wellbeing, navigation, and benefits solutions to offer a first-of-its-kind personalized health platform. The end-to-end platform makes it easier to proactively respond to people’s unique needs across their lives through a combination of data-driven personalization capabilities, a science-backed methodology, and concierge-level clinical services.
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